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Vice President, Medicare Risk Adjustment

Somatus

United States of America
  • Job Type: Full-Time
  • Function: Life Sciences R&D/Engineering
  • Industry: HealthCare Services
  • Post Date: 06/28/2022
  • Website: www.somatus.com
  • Company Address: 1861 International Dr, McLean, Virginia 22102, US

About Somatus

Somatus partners with leading health plans, health systems, nephrology and primary care groups to provide integrated care for patients with or at risk of developing kidney disease. As the market leader in value-based kidney care, Somatus’ vertically integrated clinical services and technology delay or prevent disease progression, decrease avoidable hospital utilization, improve quality and care coordination, and increase the use of home dialysis modalities and rates of kidney transplantation.

Job Description

Description:

The Vice President Medicare Risk Adjustment (MRA) will ensure Somatus is correctly coding members to ensure Health Plans get paid the appropriate premiums for their members.  The ideal candidate will have deep program knowledge and experience executing to deliver an accurate and efficient MRA program. 

RESPONSIBILITIES:

  • Managing MRA program including all aspects of the various methods of executing on an MRA strategy (e.g. prospective, retrospective, concurrent approaches).
  • Drives industry best practices and performance results focusing on driving key KPI’s (# visits, RAF score, coding accuracy).
  • Leads internal team and partners with external vendors to execute on strategy.
  • Liaison to MRA vendors ensuring operational leaders are receiving contracted for outcomes. 
  • Managing processes needed to conduct at home wellness visits. 
  • Ensure accurate coding for documentation and auditing.
  • Collaborate with payer partners.
  • Ensure processes and tools required for best in class accurate recapture rate.
  • Assist provider engagement and operations teams to maximize efficiency of provider conducted MRA visits.
  • Oversee Auditors and auditing practices.
  • Drive effective auditing documentation practices.

QUALIFICATIONS:

  • Bachelor’s Degree.
  • 8-10 years of successfully leading and executing a comprehensive MA MRA program at scale.
  • Proven track record of working collaboratively with clinical and operational colleagues across the organization. Ability to manage multiple deadlines.
  • Ability to communicate effectively and sensitively with clinicians and care teams in stressful situations. Ability to lead by influence to engage colleagues and lead teams cross-functionally. Experience in fostering networks internally and externally.

OTHER DUTIES: 

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. 

Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.  All requests for proof of vaccination or for exemptions from the vaccination requirement will be subject to any limitations stipulated by current state and/or federal laws.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.

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