Great opportunity to join the leadership team of one of the Best Places to Work in Health Care!
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. In addition to our seven health care centers, MPHC administers two health insurance plans: Generations Advantage, a Medicare Advantage plan and the US Family Health Plan. Our health plans are nationally recognized for exceptional quality and customer service. We believe that understanding both the clinical and health plan administrative side gives us the insight we need to make meaningful improvements to the health care system.
As a joined force of "people caring for people," the Martin's Point team is on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
The Director, Risk Adjustment will:
Oversee and translate MPHC strategies into operational plans and set the direction for revenue accuracy and risk adjustment efforts
Lead the development, implementation, monitoring and oversight of programs, processes and operations to Improve risk adjustment performance and accuracy of risk adjustment data collected and submitted to CMS
Develop effective relationships with key provider groups and vendors to implement successful risk adjustment optimization efforts for MPHC products
Develop and maintain knowledge and expertise in Medicare trends and best practices and educate stakeholders improvement on changes in regulations and the critical nature of risk adjustment, and recommend areas of process
Provide the leadership to ensure an engaged, high performing team, setting an example through behaviors and actions that align with MPHC culture and values
Bachelor’s degree in business, health administration, health policy, finance or a related field is required. Master’s degree strongly preferred
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.
AHIMA or AAPC (CPC) coding certification Healthcare Coding Practices preferred
Demonstrated success in improving Risk Adjustment measures
Strong managerial and staff development skills, effective team leader and builder, mentor and coach
Martin's Point offers a competitive salary and a comprehensive employee benefits program including health, dental and life insurance, short and long-term disability, 401K, earned time, 11 holidays per year, and a tuition assistance program.
Portland is Maine's business, financial and retail capital and the largest city in the state. The metropolitan hub of Maine's south coast region, Portland is a progressive, lively city incorporating the character of yesteryear into a modern urban environment. Portland is an easygoing city with friendly, hardworking people and a region that abounds in year-round outdoor recreation from the ocean to the mountains. Ranked nationally as one of the ten safest, culturally most fascinating US cities and one of the top cities for doing business, housing is affordable, and the schools and healthcare are outstanding.
Martin’s Point Health Care is an equal opportunity employer.
Internal Number: 2018-383
About Martin's Point Health Care
Martin’s Point is a health care organization leading the way to provide better care at lower costs in the communities we serve. As a not-for-profit organization, our primary mission is to create a healthier community through authentic relationships built on trust. Our administrative offices are located in Portland, Maine, though our health plans and Health Care Centers have a much broader reach in Maine and beyond.
Martin’s Point is unique because we provide both health care services and health insurance plans. Understanding both the clinical side of health care as well as the health plan administrative side gives us the insight we need to make meaningful improvements to the health care system. The Martin’s Point difference lies in our mission to exemplify and inspire health care and service excellence through leadership, education, and innovation.
Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 20...15.
Our Health Plans:
Martin’s Point offers MEDICARE and TRICARE health insurance plans. Our plans have consistently received high ratings for both quality of care and customer service. We believe strongly in giving our health plan members the best possible health care experience.
Generations Advantage Medicare Advantage Plans
Martin’s Point Health Care offers Medicare Advantage plans under the name Generations Advantage in Maine, and in Hillsborough and Strafford Counties in New Hampshire.
Generations Advantage plans are available to individuals who have Medicare Parts A and B. These plans offer comprehensive health benefits including medical, hospital, and Part D prescription drug coverage for affordable premiums. Year over year, Martin’s Point Generations Advantage plans have earned high quality ratings from Medicare.
US Family Health Plan, TRICARE Prime
The US Family Health Plan is a unique TRICARE Prime option available only in certain parts of the country. In Maine, New Hampshire, Vermont, upstate and western New York, and northern Pennsylvania, the US Family Health Plan is provided by Martin’s Point Health Care. We are proud to provide military retirees and their dependents, as well as active-duty family members, with the high quality, comprehensive health care they have earned. The US Family Health Plan goes beyond traditional TRICARE Prime benefits to offer excellent customer service, and value-added benefits including discounts on eyewear, hearing aids, fitness memberships, and more. This plan has consistently earned high ratings for quality and member satisfaction.