Medicare Advantage Revenue Director
Johns Hopkins University

Baltimore, Maryland

Posted in Education and Training


Job Info




Requisition #:617326
Location:Johns Hopkins Health Care, Hanover, MD 21076
Category:Leadership
Schedule:Day Shift

Who you are:

As the Medicare Advantage Revenue Director for Johns Hopkins HealthCare, you lead the Medicare Advantage Revenue Program line of business. You support the creation, development, and implementation of programs and initiatives, which are acutely designed to stabilize and increase the Johns Hopkins Medicare Advantage product that currently generates revenue of over $200M annually and rapidly growing.

What you'll do:

  • Lead the Risk Adjustment Program strategy for Medicare lines of business
  • Lead MA Revenue operational activities such as data submissions and reconciliations, Risk Adjustment Data Validation (RADV) audit activities as well as identification of areas of revenue improvements
  • Develop effective relationships with key provider groups (both internal and external) and vendors to implement successful risk adjustment optimization efforts for Johns Hopkins HealthCare products
  • Work with actuarial and analytics departments to establish risk adjustment analytics such as predictive modeling for coding improvement opportunities, provider coding performance, risk score trending and tracking, and transfer payment accruals
  • Ensure accurate development, analysis and reporting of key risk adjustment metrics, as well as overseeing analyses of new legislation and regulations regarding Medicare Risk Adjustment and assessing the impact of any changes in the programs
  • Coordinate with STARS and HEDIS teams to ensure alignment in strategy and vision
  • Will oversee the development of Team members to ensure timely and accurate training for current and new processes and regulations.

What you'll bring:
  • 7+ years Managed Care experience required
    • 5+ years Medicare Risk Adjustment experience required
    • 5+ years leadership and/or management experience required
  • Solid knowledge of the industry and cross-functional work experiences in the areas health insurance finance, medical economics, actuarial, underwriting, and/or risk adjustment.
  • Demonstrated success in improving Risk Adjustment measures.
  • Proven ability to make sound decisions relative to the reconciliation and revenue enhancement of Medicare Advantage products.
  • Strong analytical skills
  • Understanding of reconciliation and revenue enhancement principles
  • Demonstrated interpersonal, communications and team building skills
  • Strong oral and written communication to support executive level briefings and presentations both internal and external to Johns Hopkins HealthCare.
  • Bachelor's degree in business, health administration, health policy, finance or a related field is required.
    • Master's degree strongly preferred.

Who we are:

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins HealthCare, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.

This position is eligible for remote work.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Apply
To apply, visit https://jobs.hopkinsmedicine.org/job/medicare-advantage-revenue-director-leadership-johns-hopkins-health-care-617326-34035/








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