Manager, Risk Adjustment Analytics

WHO YOU ARE 

You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Does this sound like you? If so, we should talk.

WHO WE ARE 

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants.

We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients.

We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

YOUR ROLE 

The Manager, Risk Adjustment Analytics is responsible for the deployment of comprehensive, compliant risk adjustment analytics. This role will include providing operational insights on the completeness and accuracy of coding for all members, as well as Risk Adjustment Factor projections to support financial forecasting. Given the critical nature of complete and accurate coding which comply with CMS regulations, you will be a highly visible and essential leader across the entire organization, working with executive leadership, finance, operations, compliance and clinical teams.

PRIMARY FUNCTIONS

• Develop automated processes to calculate CMS RAF in SQL or Python that mirrors the SAS CMS RAF model and accurately calculates RAF scores for each member
• Serve as Evergreen’s internal expert as it pertains to CMS RAF model and oversee the training and development of risk adjustment models within our partner contracts
• Maintain and update RAF calculation process to account for CMS changes and updates to the model, including evaluation of new proposed RAF models and changes to submission deadlines
• Develop process to filter claims for risk adjustability based on EDS and CKCC claims filtering logic, which will be used for submission tracking and RAF calculations
• Develop processes and logic to evaluate individual condition RAF contribution as well as program or initiative RAF contribution
• Oversee the development of key analytics and data to support Risk Adjustment financial forecasts, analyses and reporting to engage key stakeholders and communicate program results to the organization
• Analyze RAF build over time and work closely with finance teams to forecast year-end RAF, leveraging historical RAF build, program RAF contribution, and demographic changes
• Establish and maintain technical and procedural infrastructure to support all aspects of Risk Adjustment (data capture, data analysis, suspecting, data submission to CMS)
• Develop analytics to track performance of leading indicators and KPIs against targets and effectively communicate performance to internal stakeholders
• Develop provider-level analytics and reporting that evaluate provider performance and deliver actionable insights for opportunity prioritization
• Create and maintain dashboards for internal and external reporting that are accurate, up-to-date, and clearly convey insights
• Support operations teams by collaborating to develop analytics required for operational execution and vendor management (chase lists, priority lists, gap lists, staffing)
• Work closely with legal and compliance teams to create and implement QA strategy for all programs based on business rules jointly agreed upon
• Work closely with data and tech teams to supply RAF analytics outputs for broader integration and ensure RAF data is correctly utilized
• Regular and reliable attendance
• Other duties as assigned, including cross market coverage as needed

HOW YOU QUALIFY

• You reviewed the Who You Are section of this job posting and immediately felt the need to read on. That makes you a match for our innovative culture
• You accept that things change quickly in a start up environment and are willing to pivot rapidly on priorities
• Bachelor’s Degree in Finance, Math, Economics, or related field
• Three (3) years of experience in healthcare financial management, healthcare consulting, and/or population health experience  
• Three (3) years of experience in risk adjustment in a Medicare Advantage environment with detailed knowledge of the CMS RAF model
• Three (3) years experience with healthcare data, specifically medical claims and/or encounter data
• Three (3) years experience with SQL and/or Python.
• Deep understanding of compliance within risk adjustment and how it supports the organization’s viability
• Experience building a robust performance monitoring and quality assurance structure
• Excellent communication skills both written and verbal
• Intermediate skills with MS Office Suite of products including Outlook and Teams
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wired to the house internet (Cable, Fiber, or DSL) and hardwired to the internet device is recommended
• Evergreen will provide Remote or Hybrid Home/Office employees with telephony applications and equipment to meet the business requirements for their position/job
• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Pay range for this role is $100,000 to $120,000, with exact pay determined based on experience, education, demand for role, and other role-specific criteria.

HOW YOU’RE SUPPORTED

• You will benefit from Evergreen Nephrology’s exceptional total rewards package, including competitive base pay with bonuses, paid time off starting at four weeks for full-time employees, 12 paid holidays per year, reimbursement for continuing medical education, 401k with match, health, dental, and vision insurance.
• We are proud to offer family-friendly policies that support paid parental leave and flexible work arrangements.
• We commit to a robust training and development program that starts with onboarding and continues throughout your career with Evergreen Nephrology.
• As an inclusive and diverse team, you will collaborate with like-minded healthcare professionals who, like you, understand the importance and value of Evergreen Nephrology’s high-quality, value-based care model.

Evergreen Nephrology is an equal opportunity employer that is committed to inclusion and diversity. We take affirmative action to ensure equal opportunity for all applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about your EEO rights as an applicant (Opens in a new window) .

Evergreen Nephrology will not discriminate or retaliate against applicants who inquire about, disclose, or discuss their compensation or that of other applicants. United States Department of Labor. Learn more (Opens in a new window).

Evergreen Nephrology is committed to working with and providing reasonable accommodations to job applicants with physical or mental disabilities. Applicants with a disability who require a reasonable accommodation for any part of the application or hiring process should email us for assistance. Reasonable accommodations will be determined on a case-by-case basis. 

Common characteristics of the people who comprise Evergreen Nephrology:

Smart, detail-oriented, mission-driven, entrepreneurial, and operates with urgency