<p>Title: Senior Director, Risk Adjustment</p> <p>Reports to: Chief Business Officer</p> <p>Classification: Director</p> <p>Location: Boston (Hybrid)</p> <p>Job description revision number and date: V 2.0; 4.18.2025</p> <p>Organization Summary:</p> <p>Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.</p> <p>As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to have earned over $40M of incentive payments in our first four years and returned 98% of those earnings directly to our participating FQHCs. We are the largest Medicaid ACO in Massachusetts (>200,000 attributed lives), and we operate national Medicare ACO contracts across several states and the District of Columbia</p> <p>As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others.</p> <p>We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. We have won "Best Places to Work" recognition from the Boston Globe for the last three consecutive years.</p> <p>Job Summary:</p> <p>Reporting to the Chief Business Officer, the Senior Director, Risk Adjustment is responsible for the success of the company's risk adjustment performance across its Medicaid, Medicare, and other lines of business. The Senior Director will have a strong performance- and finance- orientation, and will be end-to-end accountable for developing, implementing, evaluating, and maintaining a risk adjustment strategy and supporting workstreams that drive maximum</p> <p>financial value for the company and the FQHCs we work with, while complying with all relevant rules and regulations.</p> <p>The Senior Director will initially oversee a team of approximately ten FTE of risk coders. The composition and size of this team may evolve to best support our developing risk adjustment strategy.</p> <p>The Senior Director is an experienced risk adjustment professional who has led similar functions at other organizations, has up-to-date expertise on the latest Medicare risk adjustment models and best practices, and has worked with provider organizations doing change management. The Senior Director has a strong analytic and quantitative skillset and leads their work with a rigorous focus on maximizing its return on investment.</p> <p>This position will be a key leader in the organization and will have significant exposure to the executive team and other members of senior leadership, as well as to FQHC leadership teams externally.</p> <p>Responsibilities:</p> <ul> <li>End-to-end accountable for C3's risk adjustment strategy, including: </li></ul> <p>o Assessing the organization's performance and developing data-informed goals and targets for improvement</p> <p>o Identifying the areas of most significant impactable opportunity</p> <p>o Developing workstreams that address this opportunity, including performance improvement efforts with FQHCs as well as centralized activities C3 can take to close risk gaps. These workstreams include (but are not limited to) opportunities to refine C3's Epic EHR asset to maximally support risk adjustment performance, and opportunities to bring in third-party AI and other technology to support achieving maximum impact with maximum efficiency</p> <p>o Leading the implementation of these efforts</p> <p>o Monitoring and evaluating these efforts, and adjusting the strategy as needed. Taking a strong performance- and finance-orientation, leads (and directly performs as needed) constant analytics efforts to understand our evolving risk adjustment performance, opportunities, and the success and ROI of our strategies</p> <p>o Overseeing the successful achievement of C3's performance goals for risk</p> <p>adjustment with maximum ROI</p> <ul> <li>Oversees a team of Clinical Risk Coders (CRCs) and Clinical Documentation Improvement Specialists (CDIs), develops efficient and compliant workflows, and ensures ongoing team performance monitoring and quality assurance. The composition and size of the team may evolve as needed to support the risk adjustment strategy. Occasionally completes record review, coding, and auditing using electronic access to FQHC EHRs, to supplement the work of the risk coder team </li><li>Maintains expertise in ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and MassHealth and Medicare Risk Adjustment methodologies </li><li>Maintains an open and collaborative working relationship with an internal team of health center-facing staff, IT, Analytics, as well as health center leadership and risk adjustment staff </li><li>Ensures exceptional compliance with all relevant rules and regulations for all coding and billing efforts, and leads the response to any audits of risk adjustment activities </li><li>Performs other duties that arise in the course of C3's risk adjustment work </li></ul> <p>Required Skills:</p> <ul> <li>Significant subject matter expertise in risk adjustment, including Medicare. Additional experience with Medicaid risk adjustment preferred. The ideal candidate has led the risk adjustment function for another payor or ACO in Medicare and/or Medicaid </li><li>Exceptional financial and data analysis skills. Can build financial models to estimate ROI of ongoing risk adjustment interventions, can work fluently with C3's external actuaries and internal finance department, and can evaluate claims and chart data to advise ongoing risk adjustment strategy </li><li>Senior management experience. Has led medium-to-large teams, recruited and retained staff, and ideally done so during times of change </li><li>Strong interpersonal skills and experience with change management and practice transformation with healthcare providers </li><li>Excellent project management skills and attention to detail. Can take high-level direction and independently execute large and fast-moving projects </li><li>Ability to juggle multiple priorities in a fast-paced start-up environment </li><li>A strong commitment to the organization's mission </li><li>Proficiency in MS Office applications </li><li>Ability to lead with influence in a matrix environment. Ability to work collaboratively, across the organization, and as part of a team </li><li>Ability to communicate dexterously across a diverse range of stakeholders, from executive management (CEOs, CMOs, CFOs, COOs), to primary care and support staff responsible for driving the success of strategic programs on the ground </li></ul> <p>Desired Other Skills:</p> <ul> <li>Expertise with multiple EHRs, particularly Epic </li><li>Familiarity with the MassHealth ACO program </li><li>Familiarity with Federally Qualified Health Centers </li><li>Experience with anti-racism activities, and/or lived experience with racism is highly preferred </li></ul> <p>Qualifications:</p> <ul> <li>Masters' level degree education or equivalent experience </li></ul> <p>In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law.</p>