Regional Director, Burden of Illness Operations

Millennium Physician Group; Georgia; Vor Ort; USD 137.000 - 206.000; Vollzeit

Zusammenfassung

Millennium Physician Group seeks a Director to lead strategies for accurate representation of patient disease burden through compliant clinical documentation and risk adjustment practices. You will use data trends to set priorities, develop programs, and drive improvements in documentation, coding, and value-based care outcomes across physician practices.

You will lead a team, translating BOI strategy into initiatives in Risk Adjustment, Population Health, Practice Operations, Quality, Finance,

Qualifikationen

• Bachelor’s degree in Healthcare Administration or related field; CRC/CPC preferred.
• Minimum 7 years of Medicare Risk Adjustment or Burden of Illness experience.
• Minimum 3–5 years of leadership experience.
• Experience with Medicare Advantage and value-based care arrangements.
• Experience with physician practices and provider leadership.
• Proficient with analytical tools like Excel, SQL, Tableau, Power BI.

Aufgaben

• Provide leadership for organizational Burden of Illness initiatives.
• Maintain knowledge of CMS-HCC methodologies and coding guidelines.
• Monitor key BOI indicators and identify opportunities for improvement.
• Develop scalable workflows and provider education strategies.
• Coordinate BOI initiatives across Risk Adjustment, Population Health, and Clinical Operations.
• Translate strategy into actionable initiatives within physician practices.
• Monitor progress against BOI goals and adapt as needed.
• Collaborate with stakeholders to align priorities with performance data.

Kenntnisse

Risk Adjustment

Burden of Illness

Healthcare analytics

Leadership

Provider engagement

Executive communication

Ausbildung

Bachelor's in Healthcare Administration

CRC/CPC certification preferred

Tools

Excel

SQL

Tableau

Power BI

Jobbeschreibung

Job Description Summary

The Director develops and leads strategies to ensure the accurate and complete representation of patient disease burden through compliant clinical documentation and risk adjustment practices. This role uses data and performance trends to identify opportunities, establish organizational and practice-level priorities, and develop programs that improve documentation, coding accuracy, condition recapture, prevalence, and overall value-based care outcomes. The Director leads a team and is responsible for translating BOI strategy into actionable initiatives within physician practices. The Director collaborates closely with providers and leadership across Risk Adjustment, Population Health, Practice Operations, Quality, Finance, Analytics, and Clinical Operations to ensure BOI initiatives are coordinated, compliant, measurable, and successfully implemented.

Essential Duties And Responsibilities

• Provide leadership and subject matter expertise for organizational Burden of Illness initiatives.
• Maintain knowledge of CMS-HCC methodologies, regulatory requirements, coding guidelines, and changes affecting BOI performance.
• Monitor key BOI indicators.
• Identify patterns in documentation and coding performance requiring provider or practice intervention.
• Ensure provider education strategies address identified documentation and coding opportunities.
• Establish BOI priorities for physician practices based on performance data and identified opportunities.
• Develop the framework teams use to execute BOI initiatives within practices.
• Segment and prioritize practices and providers based on level of support required. .
• Monitor practice and provider progress against established BOI goals.
• Identify systemic barriers affecting practice execution and coordinate solutions across the organization.
• Develop scalable workflows that integrate BOI activities into routine practice operations.
• Ensure practice-facing BOI activities are coordinated to minimize disruption and improve provider engagement.
• Partner with partnership and market operation leadership to understand priorities, performance opportunities, and partner expectations related to BOI.
• Monitor BOI performance across populations and identify opportunities requiring intervention.
• Develop targeted improvement strategies based on identified performance gaps.
• Participate in performance discussions when BOI expertise or leadership is required.
• Ensure BOI initiatives supporting are appropriately prioritized, tracked, and executed.

Education And Experience

• Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Public Health, preferred; or equivalent combination of education and relevant professional experience may be considered.
• Active CRC or CPC certification strongly preferred.
• Minimum of 7 years of progressive experience in Medicare Risk Adjustment, Burden of Illness, population health, or related healthcare operations.
• Minimum of 3-5 years of leadership experience.
• Strong experience with CMS-HCC Risk Adjustment methodologies and reporting requirements.
• Experience working with physician practices and provider leadership.
• Experience with Medicare Advantage and value-based care arrangements required; ACO and risk-bearing arrangements preferred.
• Demonstrated experience using healthcare data to identify opportunities and drive measurable performance improvement.
• Experience with analytical and reporting tools such as Excel, SQL, Tableau, Power BI, or similar platforms preferred.

Required Skills And Abilities

• Expert knowledge of Risk Adjustment and Burden of Illness principles.
• Strong understanding of compliant clinical documentation and coding practices.
• Strong analytical and data interpretation skills.
• Ability to translate complex performance data into actionable strategies.
• Strong provider engagement and physician relationship skills.
• Ability to lead through influence across clinical and operational teams.
• Strong executive communication and presentation skills.
• Strategic planning and program development capabilities.
• Strong problem-solving and decision-making skills.
• Ability to manage multiple complex initiatives simultaneously.Strong leadership and team development capabilities.
• Ability to translate strategic objectives into measurable operational execution

Compensation Range

$137,150.00 to $205,724.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.