Population Health Program Manager (Affiliates)
WHO WE ARE
NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.
JOB SUMMARY
The NeueHealth Affiliates team is an integral component of NeueHealth’s success as it defines and ensures value-based care delivery and performance for across NeueHealth's Affiliate portfolio, spanning FFS Medicare, ACA, Medicare Advantage, and Medicaid lines of business. As the Affiliates Population Health Program Manager, you will be responsible for the evaluation of NeueHealth’s Affiliates' risk adjustment and quality program performance and the creation and delivery of education to providers and their staff. You will serve as a primary resource for Affiliate partners to educate, implement and facilitate optimization of risk adjustment and quality workflows. This role will report to the Director, Risk Adjustment and Quality at NeueHealth and cross-interface with the NeueHealth Affiliates team. The role works across departments, teams, project development offices, and lines of business to deliver best-in-class results under strict regulatory adherence and compliance mindset.
DUTIES & RESPONSIBILITIES
- Evaluate risk adjustment and quality performance for Affiliate partners and identify opportunities and risk areas
- Cultivate effective partnerships in a matrix environment of coding educators, quality, clinical, and market operations
- Implement risk adjustment and quality program leading practices at partner practice locations
- Facilitate strategic documentation, coding and quality presentations to large and small groups of clinicians, practice managers, and certified coders via virtual and in-person delivery methods (including domestic travel when necessary)
- Develop and deliver education training materials such as webinars, videos, education guides and guidelines
- Build and maintain a best-in-class coding accuracy and HEDIS / CMS quality metric knowledgebase
- Follows, reports, and adheres to all regulatory guidance, including changes related to risk adjustment methodologies and quality programs
- Ad hoc provision of pre-visit planning support and/or engagement of other resources to deliver pre-visit planning support to Affiliates
- Other duties and responsibilities as assigned.
EDUCATION AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree preferably in healthcare or technical related field or equivalent work experience required
- Three (3) or more years’ experience in various risk adjustment models (CMS HCC, HHS HCC, CDPS)
- Current AAPC or AHIMA coding certification required
- Experience analyzing risk adjustment performance and creating condition evaluation assessment key performance measures and developing risk adjustment program initiatives
- Expertise in multiple risk adjustment models and timing lifecycle required
- Experience in Quality program workflow management, leveraging technology and data
- Strong analytical skills in reviewing data used to determine performance and opportunities to improve
- Proven focus and ability to communicate coding and clinical quality concepts in multiple settings
- Experience in provider education and training required
- Advanced skills in Microsoft Office Products; Word, Excel, PowerPoint, Visio, SharePoint preferred
PROFESSIONAL COMPETENCIES
- Strong written and verbal communication skills
- Strong attention to detail
- Ability to quickly learn and adapt to meet business needs
- Experience working with multiple different learning platforms and delivery methods
- Demonstrated knowledge of risk adjustment regulations
- Ability to work independently
- Ability to build relationships with office staff, physicians, and market team
LICENSURES AND CERTIFICATIONS
- An Active, unrestricted CPC, CRC, or similar designation is required
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