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Associate Director, RA Data Reporting and Analytics

Company: Optum
Location: Everett
Posted on: July 19, 2021

Job Description:

Responsible for planning, directing and strategic oversight of the programmatic functions of the OptumCare Washington’s risk adjustment (RA) function, including accurate coding and diagnosis for risk based contracts (including Medicare Advantage and Dual Eligible, Accountable Care Organizations (ACOs), commercial or Medicaid capitation, and any other value-based performance reimbursement with chronic conditions). Responsible for the assessment, gap analysis, operational planning, deployment, and management of RA programs for prospective and/or existing partners in Washington. Under the direction of the Vice President of Risk Adjustment Operations, the Associate Director develops in-year strategies and tactics to ensure high performing RA programs supporting Optum Pacific Northwest’s growth.

ESSENTIAL DUTIES & RESPONSIBILITIES: The duties listed below are intended only as illustrations of the various types of work that may be performed.  The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment.

  • Support the development and implementation of a system that delivers great patient care consistent with the quadruple aim for all value-based programs
  • Develops strong relationships & supports the assessment, gap analysis and integration plans for prospective & existing entities in WA
  • Implements & manages RA programs at the direction of the PNW RA & Value team leadership as well as WA market leadership  
  • Supports network growth through strategic expansion of the PNW region’s value-based care contracts. This strategy includes ensuring the appropriate infrastructure and support of any new member lives through employed & affiliate engagement, deployment of point of care tools & incentive programs, and the implementation of wrap around services
  • Manages risk adjustment initiatives in our WA market, including health assessment initiatives, HCC risk adjustment data & documentation integrity, and supporting vendor programs
  • Leads the assessment, implementation, and management of attestation programs to promote complete and accurate coding & documentation activities at the point of care.
  • Leads implementation of programs designed to ensure all diagnosed codes and conditions are properly supported by appropriate documentation in patient chart.  Programs include but are not limited to: training and educational activities, clinical chart review programs, retrospective reviews, submission, reconciliation, and electronic data submission.
  • Accountable for patient engagement and outreach initiatives to facilitate comprehensive health assessment for Medicare Advantage patient population, and other managed or risk-based populations.
  • Selects and manages vendors for programs such as in-home health assessments, embedded NP, screening tools, medical chart retrieval, and medical coding.
  • Assists in the design of incentive and reimbursement programs for group constituents to incentivize appropriate coding and documentation practices related to RA activity.
  • Coordinates with clinician leadership to ensure the clinical aspects of RA and best practices are communicated to providers & clinical staff.
  • Identify and analyze implications of key changes to the regulatory & policy environment on provider organizations in the areas of risk adjustment and compliance.
  • Support effective business relationships with external entities, including payers and health plan partners with continuous focus on performance improvement related to population clinical quality and patient experience goals.
  • Organize and provide executive, management and front-line initiatives and performance reporting and communication for any manages programs.
  • Prepares timely and accurate monthly and annual reporting as required.
  • Requires significant collaboration with internal stakeholders including, but not limited to, primary care section and specialty service lines, IT, business services and finance, contracting, compliance, as well as external entities and vendors will be required.
  • Provide supplemental expertise and bandwidth in existing regional markets, as needed.
  • Leads, manages and mentors RA managerial and project management staff to support OptumCare achievement of deliverables on documentation completeness and accuracy, clinical quality and patient experience. Uses evidence-based, consistent practices in coordination with external entities and guidelines.
  • Evaluates the performance of direct report(s), including performance to identified standards and metrics for the team.
  • Consistently exhibits behavior and communication skills that demonstrates Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

Duties listed below are integrated into all job functions:

  • All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patients.
  • Must be facile at operating independently in new and ambiguous market scenarios
  • Must relate to other people beyond giving and receiving instructions: (a) get along with co-workers or peers without exhibiting behavioral extreme; (b) perform work activities requiring negotiating, instructing, supervising, persuading or speaking with others; and (c) respond openly and appropriately to feedback regarding performance from a supervisor.
  • Performs all duties in a manner which promotes and supports the Core Values and Compact of.
  • Integrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfaction.
  • Frequently must follow written and oral instructions as well as complete routine tasks independently.
  • Completes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signs Agreements.
  • Ensures confidentiality of patient information following HIPAA guidelines and OptumCare policies.
  • Attends training to meet requirements of the job position and as needed or mandated by OptumCare policies, Div. of Occupational Safety & Health (DOSH), OSHA, L&I and other state/federal regulations.
  • Has regular and predictable attendance.
  • Performs other duties as assigned.

PREFERRED QUALIFICATIONS:

Knowledge, Skills & Abilities: Note that these requirements are representative, but not all-inclusive, of the knowledge, skill, and ability required to perform this job.

  • Experience leading risk adjustment activities in a large Medicare HMO or provider organization
  • Ability to interact effectively with C-Level employees across the organization
  • Knowledge of regulations related to Medicare Advantage, Medicaid, Commercial risk adjustment
  • Knowledge of claim coding and payment methodology utilized in Medicare and Medicaid lines of business
  • Strong leadership capabilities, and ability to initiate and maintain cross-team relationships
  • Excellent analytical, actuarial, and problem-solving skills
  • Ability to effectively direct preparation of various financial analysis and data mining activities
  • Ability to effectively interface with staff, clinicians and management
  • Excellent teaming/interpersonal and verbal and written communication skills

Education: Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.  Master’s degree in Healthcare Administration, Business Administration preferred.

           

Experience: 4 - 7 years of experience in a healthcare setting.  Over 3 – 5 years of management experience.  Experience in analytics and data analysis. Preferred background in supporting risk adjustment & quality activities, clinical informatics, and fluency in Microsoft applications.

Keywords: Optum, Everett , Associate Director, RA Data Reporting and Analytics, Other , Everett, Washington

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