Director, Risk Adjustment

This role will be responsible for building a new group responsible for organizing the company’s end-to-end process on risk adjustment. In this capacity, this individual will collaborate closely with leaders from Clinical Operations, Medical Affairs, Revenue Cycle Management, and Technology. There will be a strong focus in ensuring that we have the data and software to identify and prioritize patients from a risk adjustment perspective, and in developing new and refining existing training and care delivery processes to optimize performance. This leader will evaluate the right approach to buying, building, and partnering to create the right service and software solutions for the organization.

We are looking for an entrepreneurial, versatile colleague who wants to lead a critical new function within the organization. This individual must be excited by the opportunity to spearhead the development of an important area of Business Services and must have the attention to detail and follow up skills to manage multiple priorities at once at our fast-growing company where there is tremendous flexibility to create ideas and execute new initiatives. We want someone who will thrive in an environment without established processes and with the ambition to impress and excite prospective and current clients. We also want someone who will be an excellent team player and deliver great service to colleagues.

Key responsibilities:

• Lead the development of new processes and enhance existing tools related to risk adjustment
• Partner with internal stakeholders to improve workflow, training, and auditing to drive towards top performance in risk adjustment
• Evaluate the current risk adjustment capabilities of the organization and explore opportunities to partner with outside companies to rapidly grow our capabilities
• Manage vendor contracts and relationships to augment internal capabilities in driving risk adjustment success
• Ensure that data flows bidirectionally with vendors to create highly-coordinated approach
• Develop and implement performance metrics related to risk adjustment that enables measurement of the status of our progress
• Review data and reports to identify opportunities for improved execution in achieving risk adjustment goals
• Build risk adjustment team as collaborative, high-performance group driving results within the organization
• Recruit, hire, and develop great talent to assume greater responsibilities within the team
• Collaborate with other leaders in the company, including Executive Team members, to identify opportunities for improvement in risk adjustment

Minimum Requirements:

• 3 years in risk adjustment experience at either a payer or risk-bearing provider organization
• 7 years of total work experience, including ideally analytical roles outside of risk adjustment
• Bachelor’s degree from a highly-selective university
• Ability to travel to various Upward Health geographies as needed
• Exceptional analytical and problem-solving skills, using data to develop solutions
• Detail oriented in approach to objectives and associated tasks

Knowledge, Skills & Abilities:

• High degree of ambition to take on more responsibility as the company grows and with a consistent commitment to excellent quality of work product
• Strong curiosity to learn about new and diverse areas within healthcare and different client wants and needs
• Self-starter, with high energy but also flexibility to shift directions quickly as the business requires it
• Can effectively multitask across many projects with excellent organizational skills to prioritize across a diverse range of initiatives and ensure high-priority projects are completed on-time
• Effectively anticipates needs and plan ahead, beginning tasks well in advance to prepare to seize business opportunities
• Ability to work independently and in a highly virtual environment, with colleagues all over the country
• Strong interpersonal skills to build relationships at multiple levels inside the company and with a wide array of external stakeholders
• Excellent written and oral communication skills to convey the company’s value proposition in a compelling manner
• Confidently manage small teams with increasing responsibility as the organization grows
• Strong work ethic and willingness to work long hours, including nights and weekends when required