Coding Operations &Execution - remote

Title: Coding Operations &Execution

Location: Remote, United States

JobDescription:

Datavant is a data logistics company for healthcare whose products and solutions enable organizations to move and connect data securely. We are a data logistics company for healthcare whose products and solutions enable organizations to move and connect data securely. Datavant has a network of networks consisting of thousands of organizations, more than 70,000 hospitals and clinics, 70% of the 100 largest health systems, and an ecosystem of 500+ real-world data partners.

By joining Datavant today, you’re stepping onto a highly collaborative, remote-first team that is passionate about creating transformative change in healthcare. We hire for three traits: we want people who are smart, nice, and get things done. We invest in our people and believe in hiring for high-potential and humble individuals who can rapidly grow their responsibilities as the company scales. Datavant is a distributed, remote-first team, and we empower Datavanters to shape their working environment in a way that suits their needs.

The Vice President of HCC Risk Adjustment is responsible for the oversight of risk adjustment and coding, and establishing and managing company coding guidelines, policy and procedures. The VP plays a critical role in the development and execution of business strategy and compliance, overseeing the development, implementation and execution of Medicare advantage and Managed Medicaid risk adjustment strategy.

You will:

• Strategy, planning and execution of the Risk adjustment coding business including ACA/Exchange, Medicare Advantage, and Medicaid plans.
• Demonstrate and pass on expert knowledge in HCC risk adjustment methodologies and industry-leading solutions and strategies to drive optimized results.
• Partner with Analytics to develop new predictive, analytic and reporting tools to glean actionable insights into current performance and new opportunities and leverage a network of experts –internal and external –to enhance Risk
• Adjustment innovation and performance. Integrate NLP (Natural Language Processing) technology with human coding expertise to delivery highest accuracy to clients.
• Monitor risk adjustment submissions as compared to expected revenue and proactively address gaps in data submissions and impacts to forecasting and budgets.
• Improve monitoring and auditing protocols to ensure internal and vendor compliance with all applicable regulations and risk adjustment data validation audits (RADV).
• Leverage market insights to monitor trends and external landscape, and to inform capability strategies and customer use case scenarios.
• Consult with and support Payer Client Services team with all Risk Adjustment programs and initiatives.
• Ensure operational integration of contractual requirements resulting in adherence to quality standards and performance expectations as required and strive to exceed established service level agreements.
• Oversight of the Coding management team and staff in all departmental functions including implementing best practices in talent acquisition for HCC coders, overseeing onboarding, staffing plans and staff performance to ensure optimal talent management and utilization.
• Develop and manage a multi-million dollar department budget.
• Negotiate, direct and oversee the administration of contracts, select and performance manage key vendor partners, and foster new relationships and partnerships with cutting edge service providers.
• Direct oversight of team/department and responsibilities around managing, developing, and handling employment actions of direct staff and manager
• Provide training sessions and educational resources to our client success team on the use of our coding software, coding guidelines, industry update and best practices on how to sell and discuss coding offerings with clients.
• Offer ongoing support and troubleshooting assistance to address client inquiries, issues, and challenges related to coding processes or system usage.
• Conduct regular check-ins and meetings with account managers and coding clients to understand their evolving needs, address concerns, and provide proactive support.
  • Client Relationship Management:
    • Serve as the Coding Subject Matter Expert for our client success team, fostering strong relationships and acting as a trusted advisor.
    • Conduct regular check-ins and meetings with account managers and coding clients to understand their evolving needs, address concerns, and provide proactive support.
      • Training and Support:
        • Provide training sessions and educational resources to our client success team on the use of our coding software, coding guidelines, industry update and best practices on how to sell and discuss coding offerings with clients.
        • Offer ongoing support and troubleshooting assistance to address client inquiries, issues, and challenges related to coding processes or system usage.

          What you will bring to the table:

          • Minimum of a Bachelor’s degree in business, finance, analytics, healthcare delivery, public policy or a related field is required. A Master’s degree in a related field of study is preferred.
          • Seven (7) or more years’experience in health plan, health technology for health plans, risk &quality at a plan or vendor, or a consultant in one or more of those areas.
          • Five years experience with HCC coding leadership
          • Four years experience in a in a client success / client facing role
          • AAPC or AHIMA certification preferred.
          • Strong analytical skills needed to prepare and analyze data to drive KPIs and process improvements within the department.
          • Strong leadership and management skills to directly manage a team/department.
          • Strong communication skills;ability to present information in a concise manner to multiple organizational levels including Board of Directors
          • Must be able to travel a minimum of 50% of the time (more travel may be required at times)

            Bonus points if:

            • MBA or similar degree
            • Familiarity with NLP, AI and LLM business models related to coding productivity and product differentiation
            • Product experience

              We are committed to building a diverse team of Datavanters who are all responsible for stewarding a high-performance culture in which all Datavanters belong and thrive. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status.

              Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks and industry best practices.

              We’re building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best ideas win, and personal growth is driven by expanding impact. The range posted is for a given job title, which can include multiple levels. Individual rates for the same job title may differ based on their level, responsibilities, skills, and experience for a specific job. The estimated salary range for this role is $208k-290k.

              At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your responses will be anonymous and used to help us identify areas of improvement in our recruitment process. (We can only see aggregate responses, not individual responses. In fact, we aren’t even able to see if you’ve responded or not.) Responding is your choice and it will not be used in any way in our hiring process.