Director of Risk Adjustment at Cityblock Health
Cityblock Health is the first tech-driven provider for communities with complex needs, bringing better care to where it’s needed most, block by block. Founded in 2017 on the premise that “health is local” and based in Brooklyn, we are backed by Alphabet’s Sidewalk Labs and some of the top healthcare investors in the country.
Our mission is to improve the health of underserved communities, one block at a time. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we meet our members where they are—bringing care into the home and neighborhoods through our community-based care teams.
In close collaboration with community-based organizations, local providers, and leading health plans, we are reorganizing the health system to focus on what matters to our members. Equipped with world-class, custom care delivery technology, we deliver personalized primary care, behavioral health, and social services to deliver a radically better experience of care for every member and community we serve.
Over the next year, we’ll grow quickly to bring better care to many more members and their communities. We will get started in new markets, each with their own operating structure and care teams, and continue to grow in the communities where we are working already. To do this, we need people who, like us, believe that everyone should have good care for what matters to them, in their community.
Our work is grounded in a belief in the power of a diverse community. To deliver a radically better experience of care to our members and advance equity in the communities we serve, we strive to make our own team diverse and inclusive. Our ways of working are characterized by creativity, collaboration, and mutual learning that comes from bridging together a community from diverse backgrounds and perspectives. We strive to ensure that every person on the Cityblock team, and every Cityblock member, feels like they belong, are valued, respected, and celebrated as a part of our community.
- Aim for Understanding
- Be All In
- Bring Your Whole Self
- Lean Into Discomfort
- Put Members First
About the Role:
As the Director of Risk Adjustment, you will oversee the end-to-end revenue management program and funnels and drive risk adjustment best-practices across all markets and all lines of business. This includes partnership with data teams to surface persistent and suspect diagnoses data, partnership with markets on strategies to increase visit volume, collaboration with L&D team on comprehensive provider training, partnership with compliance to ensure regulations are followed, and building a strong documentation improvement program to enable quality encounters and proper claims submission.
- Define and operationalize overarching strategy and tactical objectives for aligned with company goals and establish priorities for risk adjustment as the organization grows and evolves
- Establish a framework and plan for how risk adjustment supports Market teams in achieving their risk adjustment and broader revenue goals, cross-functional collaboration, etc.
- Direct 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
- Accountable for ensuring ongoing key performance indicators measure productivity, quality, and overall impact of the company's risk adjustment program, including reporting KPI results on a weekly/monthly basis
- Be responsible and accountable for the operational deployment of risk adjustment programs, including Medicare Advantage, Medicaid, Commercial capitation to support our value-based performance reimbursement related to RA
- Accountability over our risk adjustment levers, including our data model, our CDI program, rev cycle management, and overall reporting
- Create the infrastructure to ensure that all ICD-10-CM codes for the encounter are captured in the electronic health record (EHR) and are correctly passed to the practice management platform and submitted on a claim, including standing up a comprehensive revenue cycle management program
- Develop and recommend retrospective, concurrent and prospective processes to risk adjustment within the CBH markets and delivery models
- Develop and implement Standard Operational Procedures (SOPs), work flows, and process documentation policies for risk adjustment programs
- Oversee the training and development of risk adjustment models within our partner contracts
- Serve as point person for relationships with health plan partners, including contracting and revenue management elements of risk arrangements as well as partner oversight of ongoing performance
- Educate internal and external stakeholders on changes in regions and the critical nature of risk adjustment and recommend areas of process improvement
- Oversee implementation of new risk adjustment models and programs as we launch in new markets
- Serve as the subject matter expert in projects and initiatives
Requirements for the Role:
- You have at least 8-10 years of experience with demonstrated results as the leader of a comprehensive risk adjustment program
- You have previously led development, implementation, and operations of a successful diagnosis capture model and have overseen and managed the individual funnels across the revenue management life cycle
- You have experience building a robust performance monitoring structure around risk adjustment, ideally in a high growth technology company
- You are outcomes-focused and data driven, with an ability to bring best practices and strategies to bear quickly in overseeing the team to drive timely results
- You are an intuitive navigator of team and interpersonal dynamics, skilled at exerting direct and indirect influence in order to get things done
- You have excellent communication skills and a strong editorial mindset towards clean and crisp messaging. You can modulate content and medium thoughtfully for audience scale and seniority.
- You are a strong people manager that can appropriately balance effective delivery on goals as well as strong professional development for direct reports and their teams.
- You are a self aware leader and team member interested in feedback and growth.
- You are aligned to the Cityblock mission and dedicated to build a diverse, equitable, and inclusive team.
How We Define Success:
- You have assumed full ownership and oversight of the end to end risk adjustment model and levers
- You have a robust reporting solution in place to oversee the flow of members across the funnels as well as the flow of revenue and systems to mitigate risks of lost opportunity
- You have engaged market leaders around key operational strategies and have an infrastructure in place to track success with key strategies and partner with markets to optimize workflows where opportunities exist
What We’d Like From You:
- A resume and/or LinkedIn profile
- A short cover letter, please!
Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
We do not accept unsolicited resumes from outside recruiters/placement agencies. Cityblock will not pay fees associated with resumes presented through unsolicited means.