Company Statement
For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.
AVP, Enterprise Risk Adjustment and Data Integrity
- Bachelor’s degree required
- Master’s Degree strongly preferred
- 10+ years progressive leadership responsibility and experience in managed care, with a focus on government or state sponsored product lines required
- Minimum of five years’ work experience in government programs related to risk adjustment required
- Expert knowledge of CMS Medicare and Medicaid Risk Adjustment requirements and reimbursement methodologies required
- Experience with leading payer member recertification activities for Medicaid and Medicare lines of business required
- Exceptional business acumen and analytic skills required
- Demonstrated ability to understand and articulate complex business strategies into tactical plans and drive execution of established work plans required
- Strategic and tactical abilities in troubleshooting and solving persistent operational impediments required
- Proven ability to coordinate and lead interdepartmental work teams and meet established goals required
- Must be goal oriented and able to meet tight deadlines while handling multiple priorities required
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Sponsorship Statement
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.