VP, Quality, Revenue Optimization

Vienna, VA, United States

Description

VP- Quality, Revenue Optimization

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: "Arete." 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.

Benefits

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

Bike share discount program

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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