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.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.