We are a team on a mission, to put accessible and affordable healthcare in the hands of every person on earth. Building on the success of Babylon in the United Kingdom, Rwanda and Canada, we are building a 50-state provider network in the United States. We want to provide health services to the Medicaid population, who are often underserved and overlooked. Today, we cover over 3.5 million members in the US.

By shifting the focus from sick care to preventative care, we’re creating a better model of healthcare. One that combines AI-powered technology with the highest quality clinical expertise—so we can help people live healthier, longer lives. With over 2,000 global employees, we’ve brought together one of the largest teams of healthcare professionals, scientists, mathematicians and engineers.

Our talented team is looking to hire the best clinicians and operations talent to build and scale in the US. We’re driven by people whose ideas and energy align with our mission and our values: to dream big, build fast and be brilliant.

The Opportunity

Babylon’s goal is to establish a strong network of primary care providers that deliver quality patient care, help patients live a healthier life, and support the growth of Babylon’s US presence with a tech-forward, virtual-first, value-based care model. In order to build and support a network of primary care providers, we will need a strong team of Primary care leaders to expand these efforts.

The Manager of Risk Adjustment is responsible for managing a team of professionals to meet the needs of the Medicare and Commercial lines of business as it relates to risk adjustment.

The Manager will work in collaboration with other business leaders, and clinical leadership to develop and implement comprehensive strategies to manage and drive improvement in the end-to-end clinical documentation process, from on-boarding to claims submission and reporting.

Responsibilities:

• Manage all risk adjustment activities, including developing process flows, establishing, tracking, and meeting deadlines, managing vendor execution within contract requirements, coordinating all submission and reconciliation with internal and external stakeholders
• Lead Risk Adjustment Work Groups and deliverables in collaboration with Medical Director
• Create work plans and timelines for projects and manage risk adjustment supervisor, providing relevant training and delegation of new projects as needed to achieve team goals
• Guide process improvement efforts around coding, claims process and overall revenue cycle management.
• Track overall portfolio of projects/initiatives and integration with other key functional teams' work plans.
• Evaluate the risk adjustment strategy and submission processes of clients to identify improvement opportunities
• Provide support and guidance on risk adjustment and clinical quality operations, accreditation, quality improvement initiatives
• Support root cause analysis and develop targeted interventions designed to improve clinical quality and risk adjustment outcomes
• Work with Financial Planning and Analysis to track and evaluate the impact of initiatives and programs.
• Manage vendor relationships to support coding, claims processing, billing and collections efforts.
• Leads audit strategies of delegated parties and in plan’s regulatory risk adjustment data validation audits.
• Model and trend RAF and risk adjusted revenue and utilization costs by PMPM by plan and line of business to determine and make recommendations on overall revenue cycle impacts on an at least quarterly basis
• Calculate ROI on all vendor programs and make recommendations on contract continuation and negotiation
• Accepts and performs other duties as assigned.

Qualifications:

• Bachelor's degree in business, health administration, health policy, finance or a related field is required. Master's degree preferred
• 3-5 years of experience in Medicare and Commercial Risk Adjustment
• 2+ years of people management experience required
• Experience working multiple concurrent projects
• Demonstrates strong analytical and decision-making skills
• Demonstrated success in independently planning and managing multiple projects and reevaluating priorities in a self-directed manner and meeting challenging deadlines, and be willing to work long and flexible hours during peak project times to get the job done

Preferred Qualifications:

• Certified Risk Adjustment Coder (CRC)
• Risk adjustment experience across multiple product lines (i.e., Medicare, Medicaid, ACA)
• Quality expertise (HEDIS, NCQA Accreditation, Star Ratings)

Professional Skills and Experience:

• Demonstrated knowledge in leadership, collaboration, and performance/process improvement.
• Demonstrated knowledge in Risk Adjustment, HCC coding, annual wellness examination requirements, Medicare documentation standard, PMPM analytics
• Ability to work in a positive, respectful and productive manner with all levels of staff, physicians, and leadership.
• Excellent written, verbal, and presentation and communications skills.
• Demonstrated leadership in clinical and business operations
• Ability to build consensus
• A strong working commitment to integrity and accountability.
• Adapts personal leadership style to different situation and different people
• Maintains strategic perspective of broader impact beyond own team
• Inspires engagement and active participation of appropriate stakeholders

What does Babylon offer our providers?

• Competitive compensation
• Accrued PTO and 401K + match contributions
• Medical, Dental and Vision Insurance (full-time only)
• Flexible Scheduling