Director, Risk Adjustment And Value Based Payment

The Director of Risk Adjustment & Value Based Payment is an unparalleled opportunity with Henry Ford Health. This pivotal role spearheads strategic endeavors in Risk Adjustment, program management and Value-Based Payment, ensuring accurate documentation and navigating the transition to value-based care. Join us in revolutionizing healthcare delivery!

The Director of Risk Adjustment and Value Based Payment is responsible for Risk Adjustment program management as well as the planning and executing of strategic initiatives around value-Based Payment at Henry Ford Health System. This position is responsible for the development and execution of a comprehensive Risk Adjustment program which ensures the complete and accurate capture of documentation within the medical record and therefore appropriate Risk Adjustment reimbursement. In addition, this position is responsible for driving strategic initiatives related to value-Based Payment models, working closely with clinical, operational, population health, and financial stakeholders to ensure the health system successfully navigates the transition from fee-for-service to value-Based Payment.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Working with key clinical, operational, population health, and payer stakeholders, develops and executes a comprehensive Risk Adjustment strategy to ensure complete and accurate capture of HCC conditions and appropriate Risk Adjustment revenue from government and commercial payers.
• Ensures all Risk Adjustment activities maintain compliance with all applicable governmental, payer, and coding regulations, including overseeing routine compliance audits.
• Leads the physician education department to promote provider engagement and education around Risk Adjustment, HEDIS, and other value-based payment initiatives.
• Leads efforts to ensure the system is successful in its participation in alternative payment models, including risk adjusted contracts, Medicare Shared Savings Program ACO, and the Quality Payment Program stipulated by MACRA.
• Collaborates to establish performance metrics, provide feedback, and influence key stake holders to continuously improve documentation results and impact key performance indicators for the clinical delivery system.
• Responsible for planning and coordinating education to medical providers related to clinical documentation improvement and clinical revenue optimization.
• Monitor and analyze clinical documentation and coding accuracy trends and identify opportunities for improvement.
• Working closely with clinical, financial, and population health leaders, assists in exploring, developing, and implementing new value-Based Payment contracts and programs.
• Actively participates in various system committees including Population Health, Value Based Payment, and Revenue Cycle/Financial committees.
• Coordinates activities between multiple departments and key stakeholders, including but not limited to HAP, physician leadership, administration, operations, finance, IT, managed care, and human resources to meet project goals.
• Participates in data collection for performance measures, investigates opportunities and implements solutions for optimization.
• Creates and manages strategic partnerships with vendors and third-party systems to ensure optimization of costs and quality.
• Monitors performance of external vendors with monthly performance metrics and standards compared to benchmarks.
• Serves as an internal consultant on HCC coding, Risk Adjustment, and Value-Based Payment issues, including but not limited to industry best practices, CMS regulations and alternative payment models, ICD-10 coding, documentation, and compliance.
• Actively pursues continuing education and networking opportunities to maintain thorough knowledge of evolving best practices and new payment models within the industry; regularly consults emerging research to ensure evidence-based organizational strategy.
• Ensures that information systems support current and future needs of the department and health system as related to HCC Coding, Risk Adjustment, and Value-Based Payment. Works closely with information technology in transition planning including, but not limited to, testing, installation, and 
  education of staff to produce and maintain high quality data integrity.
• Oversees/directs the development of policies and procedures for the department.
• Establishes priorities and long and short-term strategic goals of the department with the assistance of the management team. Ensures staff is aligned with the goals and objectives related to Risk Adjustment and Value-Based Payment within Revenue Cycle and the organization as a whole.
• Prepares annual budget and manages expenses and staffing levels.
• Recruits and develops leaders, to build a culture for high performance and engaged workforce.
• Responsible for the continued integration and management of consistent processes, policies, and technology.
• Demonstrates belief in the mission of Henry Ford Health through the ability to articulate, interpret, and incorporate its mission into departmental goals and objectives.
• Supports the standards set forth in the Henry Ford Health Code of Conducts by creating an atmosphere of commitment to legal and ethical standards.

COMPLIANCE AND QUALITY MANAGEMENT

• Responsible for maintaining regulatory compliance with external agencies and state and federal regulations for medical record and coding standards, particularly related to Risk Adjustment and HCC coding. Ensures staff is kept informed and educated on process and regulatory changes. 
• Assures department functions meet all current regulatory compliance and HIPAA transaction requirements and keeps current with ICD-10 coding rules and regulations. 
• Works with risk management, legal counsel, and administrative staff, key departments, providers, and committees to ensure that the organization maintains appropriate compliance as related to risk adjustment.
• Working with appropriate system and revenue cycle leadership, ensures Risk Adjustment coding representation and participation in appropriate external collaboration, think tanks, benchmarking groups, best practices, and other initiatives at the local, state, and national levels.