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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in risk adjustment strategies, HEDIS and STAR measures, and value-based care programs. Proven ability to analyze health data, manage projects, and build relationships with healthcare providers and stakeholders.
Highest-signal resume keywords
Risk Adjustment StrategyHEDIS MeasuresSTAR MeasuresData AnalysisHealthcare Regulations
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Risk Adjustment StrategyData AnalysisProject ManagementFinancial Impact AnalysisKPI ReportingValue-Based CareQuality MeasuresRAF Score CalculationsHealthcare UtilizationImplementation Planning
Soft Skills
Communication SkillsInterpersonal SkillsRelationship BuildingCoaching SkillsPresentation Skills
Tools & Technologies
ExcelPowerPointEMR SystemsData ToolsReporting Tools
Industry Keywords
Healthcare AdministrationProvider AdministrationCompliance RequirementsP4P ProgramsProvider Incentive Programs
About the role
Key responsibilities & impact- Serve as a liaison between the provider community and Select Health
- Lead and build relationships with provider organizations, clinic leaders, and healthcare providers
- Coordinate workstreams involving risk adjustment, HEDIS and STAR gap closure, and healthcare utilization
- Navigate data tools to monitor and analyze health data, identify trends, and develop strategies to address care gaps
- Provide solutions for actionable clinic and provider opportunities and develop tailored value-based healthcare programs
- Craft implementation plans and provide insights on program effectiveness with leadership
- Advise executives on segment-specific strategies and make independent decisions on complex issues
- Work with provider groups to achieve annual goals, evaluate progress, identify business needs, and conduct provider outreach
- Monitor program, process, and infrastructure effectiveness and implement improvements
- Design and implement reporting across the risk adjustment organization and external partners
- Support HQRI strategic engagements, new member initiatives, and PPO strategies
- Coach provider partners on value-based contracts, quality measures, risk adjustment strategies, and data reports
- Lead operational strategies and facilitate implementation of services with Select Health teams and partners
- Ensure clinic interoperability, data transfer, and EMR accessibility
- Coordinate resolution of clinic and Select Health issues
- Collaborate on risk adjustment initiatives aligned with organizational goals
- Ensure regulatory compliance and industry best practices
- Manage vendors supporting risk adjustment activities
- Report monthly KPIs for specified groups, regions, lines of business, and states
Requirements
What you’ll need- Proficient at risk adjustment strategy for Medicare and ACA lines of business, including financial impact, RAF score calculations, and return of investment on engagement strategies
- Demonstrated understanding of HEDIS and STAR measures
- Knowledge of healthcare regulations and compliance requirements
- Familiarity with value-based care, provider incentive programs, P4P and quality programs
- Demonstrated ability to manage projects and teams, with a focus on achieving goals and objectives
- Excellent communication and interpersonal skills, with ability to build and maintain relationships with internal and external stakeholders
- Intermediate Excel skills and PowerPoint proficiency (MS Suite)
- Demonstrated ability to present to large groups and internal leadership
- Strong analytical skills and experience with data analysis and reporting
- Bachelor’s degree in healthcare administration, business administration, or equivalent work experience (preferred)
- Five years of experience in health plan and/or provider administration experience (preferred)
Benefits
Comp & perks- Generous benefits package covering wellness, health, security, connection, and engagement programs
- Remote work expectations and company equipment provisions for hybrid roles