Risk Adjustment Informatics Specialist/Full Time/Hybrid
🔍 Troy, Michigan
GENERAL SUMMARY:
Reporting to the Manager, Risk Adjustment and Value Based Payment, the Risk Adjustment Informatics Specialist has an important role in a high-profile group tasked with implementing system-wide improvements and new operational processes to ensure optimal and compliant participation in Risk Adjustment, HCC Coding, and other value based reimbursement models. Is responsible for complex program analytics and process improvement activities and acts with a high degree of autonomy focusing on Risk Adjustment, HCC Coding, and other Value Based Reimbursement programs. Collaborates with internal teams to develop and maintain program dashboards and report on all Risk Adjustment and HCC coding activities and proactively identify areas for improvement. Serves as a subject matter expert in all areas of Risk Adjustment methodologies and HCC coding and provide expertise to all areas across the health system. Maintains thorough knowledge of CMS and other program requirement updates and communicate changes to key technical and operational leaders to ensure continued compliance and optimal performance. This position requires strong interpersonal and communication skills and well-developed analytic and organizational skills. Develops and implements a comprehensive program to collect data and effectively report information from data to a variety of customers including conducting complex statistical analysis and developing new approaches to measurement and analysis. The customers and end users of this support service include physicians, other clinical service and hospital leaders, Revenue Cycle leadership, physician groups, the Board of Trustees, System leadership, and external oversight/regulatory bodies. This position generates reports and supports comparative data base assessment and maintenance regarding strategic and operational performance for performance review, operational effectiveness, and improvement efforts. The Risk Adjustment Informatics Specialist is a highly analytical thinker with talent for scrutinizing diverse data sources to identify areas of improvement in Risk Adjustment and HCC Coding
EDUCATION/EXPERIENCE REQUIRED:
• Bachelor’s degree with a health care, science or business focus and strong technical computer knowledge or a bachelor’s degree in computer science with strong health care experience required.
• Master’s degree or equivalent experience in health care, science, business, engineering, or computer science preferred. • Five (5) years of experience in a healthcare or business setting required.
• Seven (7) years of experience in a healthcare or business setting preferred.
• Quantitative analysis experience in data science capabilities including data mining, predictive modeling, machine learning, statistical modeling, large scale data acquisition, transformation, and structured and unstructured data analysis.
• Extensive experience in Risk Adjustment methodologies, Risk Adjustment Factor Score calculation, governmental programs, and HCC coding.
• Knowledge of and access to relevant System data or data gathering techniques.
• Expert in the use of Microsoft Office products, particularly Excel, but also Access, PowerPoint, Word, Project, PowerBI.
• Extensive knowledge of Medicare, Medicaid, Blue Cross and other third-party payers billing and reimbursement regulations/policies, particularly around Risk Adjustment, HCC Coding, and other value-based reimbursement programs.
• Experience in gathering and organizing data and information from disparate sources and presenting findings to leadership in a way that is useful for decision support, benchmarking, and quality performance tracking.
• Excellent oral and written communication skills, including the ability to teach complex technical/analytical concepts to System leadership, management, and staff.
• Comfortable communicating complex ideas and strategic recommendations to clinicians and executive leadership.
• Strong interpersonal skills; ability to communicate effectively with all levels of management and staff across the System.
• Project management and/or LEAN, Six Sigma experience a plus.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.