About Us

Upperline Health launched in 2017 and is the nation’s leading comprehensive and coordinated lower extremity healthcare organization. Upperline Health provides the highest quality integrated health services to more patients in need through a skilled and compassionate team. We specialize in targeting patients at risk of developing complications and intervening earlier with an innovative care management approach to prevent more serious consequences. Upperline Health is based out of Nashville, TN and currently has practices in Alabama, California, Florida, Georgia, Indiana, Kentucky, and Tennessee.

Benefits

Comprehensive benefit options include medical, dental and vision, 401K and PTO.

About the Director of Risk Adjustment

Upperline Health is seeking a Director, Risk Adjustment, who will be responsible and accountable for the planning, buildout, and execution of our company-wide risk adjustment program. The Director, Risk Adjustment will have direct accountability for the success of the program and will collaborate with value-based care leadership, data analytics and actuarial team, providers, and regional operations to ensure engagement and compliant execution of the program. To be successful in this role, this individual will have experience in risk adjustment, HCC payment methodology and coding. This person should enjoy fast paced environments, rolling their sleeves up to problem solve, and constantly adapting the processes and systems to support our physicians in the field and our ACO initiatives.

This is a remote position.

What You’ll Do

• Partner with leadership to develop risk adjustment strategy, including the ideal team structure, member engagement strategy, and member retention strategy
• Develop and implement best practices and workflows for the risk adjustment program to ensure timely and accurate coding
• Assist in recruiting and onboarding additional team members needed to roll out the program company-wide
• Collaborate and consult with providers, data team, clinical leadership, and operations to successfully implement the risk adjustment program
• Build and strengthen relationships with providers to achieve improvements in risk adjustment program participation and data validation
• Present HCC/RAF performance results and findings, including the overall HCC/RAF score, improvement strategies and tactics to leadership on a regular basis
• Manage, support, and develop team members for continuous improvement; create and implement performance improvement plans when needed
• Assist with all auditing and oversight that is requested of the in-market program
• Maintain an expert level of knowledge of Medicare and HCC risk-based reimbursement methodologies, policies, and best practices
• All other duties as assigned

Qualifications of the Director of Risk Adjustment

• Bachelor’s degree required
• 6+ years of experience in managed care or physician practice management with focus on government programs
• CMS HCC Risk Adjustment Model expertise required
• Experience working on both provider side and payer side is strongly preferred
• Management experience must include previously leading risk adjustment program teams
• AAPC certifications preferred
• Familiarity with various population health tools
• Athena EMR experience or exposure is a plus
• Demonstrable success creating efficient processes and systems
• Excellent problem solver with a talent for synthesizing complex projects and translating high-level goals into actionable plans
• Self-starter with an entrepreneurial spirit who is determined and nimble to work in a fast-pace and evolving environment
• Exceptional collaboration and communication skills

Compensation

Compensation is commensurate to compensation for similar positions in the region and based on prior training and experience

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Job Type: Full-time

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