Manager, Healthcare Informatics
Location: Pearland Administrative Office
Department: KS Plan Advantage
Job Type: Full Time
Kelsey-Seybold Clinic. Your Doctors for Life.
Kelsey-Seybold Clinic is Houston’s premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey. With 19 clinic locations and more than 400 physicians, Kelsey-Seybold provides medical care in 55 medical specialties and is home to a nationally accredited Breast Diagnostic Center, Endoscopy Center, Infusion Center and Cancer Center. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.
The Manager will serve as the Medicare Risk Adjustment and HEDIS subject matter expert and oversee a team of data analysts that provides data, systems support, and analysis for managing all financial aspects of risk adjustment and quality reporting. The team operates the CMS Encounter Data and HEDIS vendor software solutions and implements reporting and analysis specific to Medicare risk adjustment, RAPS, EDPS and HEDIS. The team analyzes and researches all encounter data errors and issues, collaborating with internal departments to work toward error resolution. The team is responsible for calculating and analyzing member-level risk scores and provides data and analytical support to the HCC Coding team who conduct medical record review.
This position will have responsibility for managing the data, workflows, and applications used in the CMS Encounter Data, RAPS, and HEDIS submissions and analysis and will be responsible for leading projects and engaging collaboration within Finance, IT, Claims and Enrollment areas to optimize risk adjustment and quality reporting results. This position will also support analysis related to maximizing star ratings from CMS and quality measure reporting for commercial employers. The position will review and apply all related regulatory requirements related to department activities including: CMS audits, changes in risk adjustment models, changes in submission requirements, HEDIS data validation, etc.
Key responsibilities of this position include:
Participating as a key member in strategy discussions and meetings with the KS executive team, third party payers, and employers
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
Bachelor’s Degree in Finance, Economics, Mathematics, Healthcare Administration, or related field
MBA or MHA preferred