Director of Medicare Risk Adjustment
PHP - Medicare Risk Adjustment
PIH Health Physicians
40 hrs a wk.
POSITION SUMMARY: The Director of Medicare Risk Adjustment will provide clinical leadership and consultation across the organization and contracted providers regarding Medicare’s Risk Adjustment and Five Star program to ensure appropriate services are rendered and to optimize complete and accurate capture of medical diagnoses. This position will also profile provider performance; manage a team of coders and administrative staff in data mining and analysis; manage projects and outreach opportunities in support of Five Star and Hierarchical Condition Code (HCC) Medicare programs and initiatives including gathering and evaluating clinical data from the organization’s electronic medical records system. QUALIFICATIONS: Three (3) years of experience working with physicians preferably in Quality or Risk Adjustment or Project Management related areas; two (2) years of management experience; knowledge of HCC and Five Star processes and reporting requirements; Clinical licensure preferred; valid CA driver’s license.
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