About Our Company

At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. Doctors today are faced with the reality of spending more time on administrative tasks than caring for patients. Physician burnout and fatigue are an epidemic, and the healthcare experience and quality suffer as a result. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve.

About Your Team

Are you looking to build your career leading a high performing Risk Adjustment program and be part of a growing and dynamic team? Altais and our subsidiaries, form one of the most recognized medical groups in California. We are 2,700+ physicians, working in over 40 cities in California, caring for more than 350,000 patients. For Altais, Risk Adjustment is more than a reimbursement program; for us, a high performing Risk Adjustment program works with our clinical programs and resources to ensure patients receive the highest quality care from our physicians to support their health goals. If working with highly competent, hard-working, thoughtful clinicians who value good ideas and are passionate about reshaping healthcare excites you, then we are thrilled to welcome you to your new career.

This position is a hybrid remote position. Our office location is based in Oakland City Center location.

About Your Work

As the Director of Risk Adjustment, you will be responsible for ensuring the organization has an efficient and compliant risk adjustment program. As part of a cross-functional team, you will work directly with clinicians, certified coders, IT, enterprise analytics, network management and physicians. You will own accountability for ensuring our members’ medical record is complete, accurate and represents accurate member conditions.

You will focus on

• Director of Risk Adjustment Program:
  • Provides leadership and direct support for risk programs across all lines of business
  • Ensures that Risk Adjustment programs comply with all applicable federal and state guidelines
  • Deploys programs to ensure members’ medical record is complete, accurate and represents accurate member conditions
  • Lead the design of a high performing, compliant risk adjustment program including leading analytical and operational teams for successful delivery of programs including:
    • Deploying a comprehensive coding and documentation program,
    • Retrospective and prospective chart review,
    • Abstraction and encounter submission
    • Provider engagement and education programs
    • Annual Health Assessment programs
    • Ensure the appropriate strategy, tactics and data capture processes are in place and in compliance with regulations
    • Participate and manage all regulatory audits
  • Develops and implements provider education strategies and tools, monitors provider performance, develops improvement plans and assists physicians/care teams to ensure patients are accurately assessed for medical conditions
  • Engages with enterprise functional areas to ensure Members with complex/chronic conditions are referred to care management programs
  • Compose and distribute education materials to physician and vendors to aid the collection of complete and accurate member profile documentation
  • Stay informed of all risk related program requirements from CMS and develop implementation strategies to CMS requirements
  • Oversee implementation of risk adjustment analytics platform and related technological solutions, including Epic integrated tools
  • Creates a culture focused on Compliance
  • Provides ongoing updates and policy modifications distributed by CMS
  • Serves to alert relevant stakeholders and propose new operational policy/processes to comply with regulatory mandates
  • Perform management responsibilities including hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity; has budgetary responsibility and authority

The Skills, Experience & Education You Bring

• 10 years of experience in Managed Care, large medical group / IPA, Payer Provider Health Plan, Health system management.
• 10 years of experience in risk adjustment markets (Medicare Advantage/commercial).
• 10 years of experience with Chart Review, In Home assessment, Provider education, Prospective programs and encounter submissions; knowledge of billing rules and systems
• 6 years of management experience
• Certified Coder, highly desirable

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious- willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create, knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Pre-Employment

A pre-employment background check will be conducted for all positions. All offers of employment are made on a contingency basis. All prospective employees must pass a medical exam (fitness for duty) and also provide proof of American citizenship, or legal resident status and the legal right to work in the United States.

Prospective employees with patient contact are also required to submit and successfully pass a medical examination, drug test and TB (PPD) test by our designated physician. Brown & Toland Health reserves the right to rescind the contingent offer of employment to any prospective employee when the results of pre-employment checks or tests are not acceptable to Brown & Toland Health.