Director, Risk Adjustment Program Integrity

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Job Description

A bit about the Risk Adjustment Department:

At Devoted, we see risk adjustment as taking care of members like family by funding better care & better benefits through the complete and accurate documentation of members’ true conditions.

A key component of ensuring we treat every member like family is making sure we treat our team members like family. We have our Risk Adjustment department organized into five functional areas:

• Coding Quality
• Data Submissions
• Program Integrity
• Prospective Program
• Retrospective Coding Program (Internal and Vendors**)**

While each functional area owns a specific set of outcomes, the complexity of risk adjustment requires significant collaboration to ensure our risk adjustment program is highly compliant and operationally effective.

A bit about this role:

Robust oversight is essential to ensure that Devoted’s Risk Adjustment program adheres to the letter and spirit of the law while adapting to an evolving regulatory and enforcement environment. The Risk Adjustment Program Integrity team plays a critical role in Devoted’s 3-layer oversight model.

1. Risk Adjustment Program Integrity - Our Program Integrity team is embedded within our operations and oversees our risk adjustment activities & data through the development & execution of our Oversight Work Plan. Key oversight activities include:

• HCC audits
• External reviews
• Devoted Coding Guidelines
• Provider oversight & education
• Documented policies and procedures
• Employee training
• CMS overpayment reporting
• Supporting annual CMS attestation

2. Devoted’s Compliance Team - Our Compliance Team oversees our internal oversight through:

• Dotted line reporting structure between Director of Risk Adjustment Program Integrity & Chief Compliance Officer, including deep engagement in the development of our oversight plane and audit observations
• Execution of independent audits and assessments
• Reporting to, and engagement with CMSs
• Reporting internal audit results to Board of Directors

**3. Regulatory and enforcement agencies - CMS, the OIG, and the DOJ actively oversee risk adjustment practices of MA plans.

Regulatory and enforcement agencies - CMS, the OIG, and the DOJ actively oversee risk adjustment practices of MA plans.

Your Responsibilities and Impact will include:

• Develop and oversee Devoted’s Risk Adjustment oversight program
• Responsible for the execution of Devoted’s Oversight Work Plan and all related collateral/documentation
• Participate on the Risk Adjustment Sub-committee and create artifacts to be shared with Devoted’s Board of Directors and Enterprise Risk Management committee
• Support external audit readiness
• Serve as an expert on evolving enforcement landscape
• Act as key expert in, and advisor to, Risk Adjustment Operations policies and procedures

Required skills and experience:

• Experience drafting artifacts to memorialize actions and decisions

• Experience working in fast-paced environments and facilitating complex discussions with product/tech and executives

• Experience with leveraging analytics and critical thinking to digest complex quantitative information and produce rigorous insights

• Proven track record of developing subject matter expertise

• Proven success developing and operationalizing KPIs

• Proven success influencing a broad range of stakeholders (Individual contributors, executives, peers, and external parties)

• You have over 7 plus years of experience building successful operational models

• You have experience navigating highly regulated industries, Medicare experience preferred

• You have capacity for high throughput and working both autonomously and with others

• You build strong cross-functional relationships

Desired skills and experience:

• Medicare/Healthcare experience
• Compliance experience

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Salary Range: $164,000-$203,000

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.