Director, Risk Adjustment Operations

Job Description

This role is fully remote and must be located within the 50 U.S. states. Preference for residence in the Greater Boston Area. Standard working hours are in Eastern Timezone. Semi-annual travel may be required to a Devoted office for on-site work.

A bit about this role: 

We are seeking a strategic and high-impact leader to serve as the Director of Risk Adjustment Operations. This pivotal role owns the end-to-end operational success of two core pillars within Devoted’s Risk Adjustment Department: Data Submissions and the Retrospective Chart Review Program.

This role will lead the teams responsible for the successful submission of Devoted’s disease burden reporting by optimizing our internally developed Centers for Medicare & Medicaid Services (CMS) data submission engine while managing a high volume, multi-vendor retrospective medical document review operation. The objective is to achieve 100% complete and accurate acceptance of risk adjustment data through robust metrics, scalable workflows, and expert vendor management. You will directly engage with AI-enabled tools to optimize our processes

Your Responsibilities and Impact will include:

Data Submissions

• Develop, implement, and achieve KPIs that measure and monitor the successful submission of our risk adjustment data

• Manage relationship with Devoted’s data submission pass-through vendor, and CSCC Operations, CMS’ data submission team

• Read and make determinations on how new and emerging CMS technical guidance impacts our data submission operations 

• Maintain our data submission policies, including our policy on how we internally validate, clean, and apply inclusion and exclusion criteria to the data we submit to CMS

• Support other areas of the Risk Adjustment department to ensure end-to-end perspectives are considered for all policy and procedure decisions

Retrospective Chart Reviews

• Lead the strategic execution of the multi-channel Retrospective Chart Review Program, including defining, monitoring, and enforcing rigorous Service Level Agreements (SLAs) and Key Performance Indicators (KPIs) for internal teams, offshore partners, and external vendors

• Oversee medical record retrieval in partnership with the Clinical Data Acquisition team

• Own and improve program forecasts and capacity modeling

• Evaluate and integrate AI technologies to optimize the end-to-end chart review workflow, from medical record retrieval through evaluation

• Support QA and audit processes to achieve or exceed 95% coding accuracy

• Support other areas of the Risk Adjustment department to ensure end-to-end perspectives are considered for all policy and procedure decisions

Required skills and experience: 

• Proven operator with a track record of transforming complex operational challenges into scalable, practical, and elegant business processes

• Systematic and detail-oriented approach to leadership, with a fierce commitment to quality, accuracy, and operational excellence

• Deeply analytical and research-oriented, with the ability to digest intricate regulatory or technical guidance and seamlessly incorporate it into daily operations

• Ability to manage and lead through ambiguity

• Can-do attitude and stamina for tackling hard problems

• High level of self-motivation and an ability to balance multiple priorities across initiatives

• Results-oriented: you are energized by having an ambitious goal and the latitude to execute against it

• Natural relationship builder and able to work well in a cross functional team environment

Desired skills and experience:

• Experience managing multiple teams and vendors

• Fast learner, can pick up new content/industries quickly in an extremely fast-paced tech environment

• Proven organizational, communication, and leadership skills

• Prior experience in Medicare Advantage risk adjustment, in particular RAPS and EDPS data submission and retrospective chart reviews preferred but not required
  Salary range: $144,000- $216,000 annually

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.