VP, Quality, Revenue Optimization
Company: AArete
Location: Chicago
Posted on: May 18, 2024
Job Description:
Management Consulting ServicesUnited States AArete is
one-of-a-kind when it comes to consulting firm culture. Why AArete?
We are a global, innovative management and technology consulting
firm , with offices in the U.S., India, and the U.K . Our name
comes from the Greek word for excellence: "Aret--." And excellence
is exactly what we strive for. Our success starts with enriching
and empowering our people. From robust career development planning
to competitive life and wellness benefits, AArete's "Culture of
Care" takes a holistic approach to the employee experience. At
AArete, we encourage you to unlock your full potential by directly
contributing to our mission and prioritizing space for personal
development and fulfillment. The Role We are seeking a dynamic and
experienced professional to fill the role of Vice President (VP) -
Quality, Revenue Optimization. The ideal candidate will have a
strong background in healthcare payer/provider operations, with a
focus on quality improvement, revenue optimization, and compliance
within the healthcare payer Medicare, Medicaid, and Marketplace
lines of business . The VP will oversee and drive initiatives to
enhance operational efficiency, quality performance, and revenue
optimization strategies. Additionally, this role will work with
other team members to build data analytic solutions that can
improve our overall assessment of our client's current processes
and performance as they relate to medical encounter processing,
care gap assessments, predictive models, dashboards, etc. Work
You'll Do
- Develop and execute strategies to optimize revenue through
quality improvement initiatives, leveraging in-depth knowledge of
Quality Stars (Medicare), HEDIS (Medicaid), and Risk Adjustment
processes.
- Provide leadership and guidance on operational performance
measures, including Administrative Measures and Hierarchical
Condition Codes (HCC) for risk adjustment.
- Lead risk adjustment assessments to identify opportunities for
improvement and to ensure accurate coding, documentation, and
submission practices to maximize revenue opportunities.
- Lead cross-functional teams to implement industry-leading data
analytics, reporting, and modeling practices to support risk
adjustment initiatives and quality improvement efforts.
- Ensure compliance with regulatory requirements and industry
standards related to risk adjustment practices in Medicare,
Medicaid, and Marketplace programs.
- Stay current with industry trends, best practices, and changes
in risk adjustment methodologies, quality measurement, and revenue
optimization strategies.
- Coach and mentor others (internal and external) as to the value
of these programs within the healthcare payer, the influence
potential within the healthcare providers and improve the overall
evaluation of opportunities to support client solutions.
- Manage and foster relationships with internal stakeholders,
external partners, and regulatory bodies to drive continuous
improvement in risk adjustment and quality outcomes.
- Leverage your network and business relationships to identify,
groom and win opportunities for AArete to help healthcare payers
with their compliance and quality practices (including but not
limited to modernization, improved analytics, regulatory
interpretation, audit readiness, etc.) Requirements
- Minimum of 10 years of experience in healthcare payer/provider
operations, with a focus on quality improvement, revenue
optimization, and risk adjustment.
- Expertise in Quality Stars (Medicare), HEDIS (Medicaid), and
Risk Adjustment best practices .
- Strong understanding of Hierarchical Condition Codes (HCC) and
risk adjustment models.
- Experience leading risk adjustment programs and vendor
solutions , including accurate coding and documentation
practices.
- Familiarity with industry solutions for data analytics,
reporting, and modeling practices (either custom built or
commercial off the shelf) .
- Thorough knowledge of compliance-related aspects of quality and
risk adjustment practices within Medicare, Medicaid, and
Marketplace programs.
- Excellent communication skills, both written and verbal, with
the ability to present complex information effectively to diverse
audiences.
- Technical background and experience working with IT and data
analytic tools.
- Familiarity with healthcare payer / provider relationships and
data sharing arrangements that can improve the overall results to
both.
- Proven ability to manage encounter processing and service level
agreements to drive operational excellence.
- Flexible PTO, monthly half-day refuels, volunteer time off, 10
paid holidays
- Own Your Day flexible work policy
- Competitive majority employer-paid benefits: Medical, Dental,
Vision, 401K Match
- Employee Stock Ownership Plan
- Generous maternity/paternity leave options
- Completely employer paid Life Insurance, STD, LTD
- Charitable contribution matching program
- New client commission opportunities and referral bonus
program
- Video-free Fridays About AArete AArete is a global management
and technology consulting firm specializing in strategic
profitability improvement, digital transformation, and advisory
services. Our cross-industry solutions are powered by modern
technology, market intelligence, and big data to drive purposeful
change and actionable outcomes. AArete is guided by our deeply
embedded principles: Excellence, Passion, Loyalty to Clients,
Stewardship, Family, Community, Sustainability, and Inclusion. We
are proud to have earned a Great Place to Work Certification and
named one of America's Best Management Consulting Firms by Forbes,
Vault's Top 50 Firms to Work For , Crain's Chicago Business Fast
50, Inc 5000's Fastest Growing Firms , Consulting Magazine's
Fastest Growing Firms . AAP/ EEO Statement All qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, disability, or status as a protected veteran.
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Keywords: AArete, Evanston , VP, Quality, Revenue Optimization, Executive , Chicago, Illinois
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