Director, Clinical Data Acquisitions & Member/provider Services

Director, Clinical Data Acquisitions & Member/Provider Services

The Director, Clinical Data Acquisition & Member/Provider Services is critical for ensuring that an organization obtains the necessary patient health information for quality improvement initiatives, risk adjustment, and regulatory compliance. Responsible for the implementation, monitoring, and oversight of all chart collection for HEDIS, or HEDIS-like projects, Risk Adjustment, Risk Adjustment Data Validation, and other state specific audit projects and deliverables. Also works with the Health Plan and other contracted entities to strategically plan for supplemental data sourced (SDS) to be sent from and ingested into the quality/risk reporting system. Oversees management and training for team members as well as training on the quality/risk reporting systems.

Will be the primary point of contact for member/provider related issues and concerns. Leads and directs the team to ensure high standards of service. Working in collaboration with other departments and stakeholder to align services with member/provider needs, along with overseeing the risk management reporting system and training.

Required Skills

• Superlative people and customer service skills
• Exhibits professional management skills including time management, organizational, and prioritization skills
• Demonstrates ability and skill through prior experience and/or academic expertise in actively leading and managing large-scale change
• Current knowledge of health plan audit programs and survey programs such as CMS Stars, PAS, PAAS, IHA AMP, Risk Adjustment, MIPS, and other related audit activities
• General knowledge of Information Systems technology. Ability to discuss system problems and requirements with managers and employees in user functions, and be able to present findings in verbal and written form
• Develops reports for executive, practitioners, and staff on the quality performance

Required Experience

Required:

• Bachelor's Degree
• Five (5) or more years of project experience/data management
• Knowledge of American Recovery and Reinvestment Act (ARRA) Merit-based Incentive Payment System (MIPS)
• Knowledge of quality and risk reporting programs (IHA AMP, CMS Stars, QPP and HCCs)

Preferred:

• Clinical experience working with quality management systems similar to those at PIH Health

Minimum Salary

$130,790.40

Maximum Salary

$215,800.00