Risk Adjustment Program Manager
Who we are:
Cityblock Health is a new type of healthcare company, operating out of Brooklyn and backed by Alphabet’s Sidewalk Labs, along with some of the top healthcare investors in the country.
Our mission is to radically improve the health of urban communities, one block at a time. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we bring the capability to deliver care in the home and neighborhood with our field-based teams.
In close collaboration with community-based organizations and leading commercial partners, we are reorganizing the health system to focus on what matters to our members. We deliver personalized primary care, behavioral health, and social services through a network of neighborhood hubs with deep community-based partnerships and world-class technology.
We partner with payers and at-risk providers, accepting capitated financial risk to care for their most vulnerable, high and rising risk members. Additionally, we invest in strategic partnerships with community-based and social services organizations, in some instances bringing them into the value equation through sub-capitation and performance-based compensation.
Over the next year we’ll grow quickly, including entering new markets, developing new partnerships, and expanding our team. This role is a key contributor to the success of our “Block” (headquarters site) and our full team.
In this role, you’ll be the inaugural leader of Cityblock’s risk adjustment program, which will provide critical business and clinical services to our associates across markets. The ideal candidate has established her/himself as an expert in Medicare Advantage and/or Medicaid managed care risk adjustment for a health plan and/or health care provider that is heavily oriented toward quality and value-based care delivery, and has experience building new teams and functions from the ground up. This role will report to the Chief Operating Officer.
- Lead execution and oversight of Cityblock’s risk adjustment program across all markets, providing leadership to the development of strategy, policy, implementation, administration, goals, progress, and improvement of the program.
- Develop and maintain risk adjustment programs to meet all regulatory requirements at the federal level (i.e., CMS HCC model and program) and market level (e.g., CDPS, CRG or other model developed and used by state Medicaid or commercial exchange programs)
- Partner with Cityblock’s health plan operations leaders to manage the Medicare Electronic Data Processing (EDPS) data submission process, ensure that all available data is accepted by CMS, and manage the transition from RAPS to EDPS.
- Serve as the business owner for Cityblock’s risk adjustment data infrastructure, supporting applications and tools
- Lead the development of analytics to support the risk adjustment program and feed downstream reporting to other areas of the organization
- Collaborate with leadership to develop an ongoing improvement plan, set goals, and estimate resources for the risk adjustment program (in collaboration with clinical and quality leadership)
- Assist in training and coaching internal Cityblock associates and external network partners on risk adjustment concepts, critical success factors, and proper coding and documentation requirements
- Collaborate with Finance leadership on accounting, budgeting, planning and forecasting effort
- Collaborate with Compliance and Quality leadership to ensure compliance with federal and state rules and regulations; play a key role in preparation for RADV audits
- Assists in developing a long-term plan to develop Cityblock’s technology and platform capabilities to support the risk adjustment program; serve as the business owner for technology and platform capability development efforts
- Serve as a subject matter on the topic of risk adjustment across business and clinical functions
- Assist in managing vendor contracts related to risk adjustment
- Lead policy and procedure revisions and the development and implementation of new policies and procedures
- Bring a continuous improvement mindset that drives innovation to identify and implement incremental efficiencies over time
- Monitor and manage to key operating, financial and quality metrics
- Lead related and ad hoc operations projects
- Hire, train, coach, and evaluate performance of direct reports
You’d be a good fit if you have:
- 5+ years of experience in risk adjustment management within a large medical practice, health plan, or risk adjustment vendor; 3+ of those 5 years as a manager
- Mastery of important risk adjustment methodologies (i.e., CMS HCC, CDPS and CRG)
- Knowledge of how to lead functions related to coding, risk adjustments, medical record review project management, encounter data management, and compliance audit
- Knowledge of regulations related to data submission for Medicare Advantage, Medicaid and Marketplace risk adjustment programs
- Highly organized with a strong attention to detail
- A strong analytics and finance background
- Demonstrated an ability to execute within a fast-moving work environment
- A bachelor’s degree with focus on healthcare, engineering, business, economics, statistics, or mathematics
Nice to have:
- Direct experience in a capitated, value-based medical group
- Direct experience in a high growth technology company
- Direct experience leading teams to build operations from the ground up
- MBA or MS
“Nice to have” really means “nice to have”. It’s completely possible that you don’t have any of these and are still a great fit for the team.
You should include these in your application:
- A resume and/or LinkedIn profile.
- A short (2-3 paragraph) cover letter
Cityblock values diversity as a core tenet of the work we do and 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.