Associate Director, RA Data Reporting and Analytics
Posted on: July 19, 2021
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
- 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
- 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 &
- 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
- Prepares timely and accurate monthly and annual reporting as
- 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
- 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
- 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
- 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
- Frequently must follow written and oral instructions as well as
complete routine tasks independently.
- Completes annual compliance training on
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
- Has regular and predictable attendance.
- Performs other duties as assigned.
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
- 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
- Ability to effectively direct preparation of various financial
analysis and data mining activities
- Ability to effectively interface with staff, clinicians and
- Excellent teaming/interpersonal and verbal and written
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
Keywords: Optum, Everett , Associate Director, RA Data Reporting and Analytics, Other , Everett, Washington
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