Director Risk Data and Reporting-SWHR CIN

Southwestern Health Resources Clinically Integrated Network (SWHR CIN), is hiring for a Senior Director Risk Data and Reporting. Under the general supervision of the VP Financial Planning & Analysis, provides technical expertise and operations to the department in order to set, or exceed specified targets. Oversees the creation and management of all working files to be utilized by the VP based on criteria established by the leadership team. Location: Farmers Branch Core Hours Full time, Monday through Friday, 8am-5pm Job Description Primary responsibility for all file creation and submissions as well as responsibility for ensuring files are accepted with a satisfactory error rate within the required timeline. Creates and publishes internal calendar for all submissions to include internal due dates as well as file submission deadlines. Must take into account all vendors as well as provider partners when developing the due dates and must specify when task are dependent on other resources. Develops and manages processes for working rejection and updating files to meet new payor or CMS requirements. Manages vendor relationships as they pertain to file creation, submission etc. Develops strategy to meet all CMS standards and timelines for Risk Adjustment file submissions. Direct accountability for file submission processes and error processes. Responsible for reporting including weekly review with Executive team. Responsible for vendor supervision as it relates to Risk Adjustment files. Develops, implements, and/or maintains documentation consistent with CMS regulations, company goals and policies. Must have extensive expertise in Risk Adjustment processes and procedures. Must work closely with our Business Intelligence team to transfer files and develop reports. Assists in the development and maintenance of monthly, quarterly, and annual reports utilized for strategic and tactical decision making. Education Bachelor''s Degree required Experience 8 years experience to include 5 years management experience (3 of which include management level in risk adjustment and/or Quality working with Medicare Advantage plans) required Skills Excellent problem solving , communication, and organizational skills. Ability to motivate team and hold team accountable for results. Ability to handle multiple projects and heavy workloads. Ability to work independently or as a team. Excellent knowledge of file transfer and audit processes as they relate to Risk and Quality Excellent knowledge of Microsoft Office (Excel, Work, PowerPoint) Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region''s leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N'' Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region. The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation''s leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017. At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all. We invite you to learn more about us at Let''s move healthcare forward - together. Additional Information Location: Dallas, Texas, United States Shift: Day Job Schedule: Full-time Pay Basis: Hourly Minimum Salary: US Dollar (USD) 45.63 Market Salary: US Dollar (USD): 60.50 Maximum Salary : US Dollar (USD) 79.64

Created: 2021-11-29