Senior Director, Risk Adjustment

Kelsey-SeyboldHouston, Texas | July 1, 2022

The Company

Founded in 1949 in Houston’s renowned Texas Medical Center, Kelsey-Seybold Clinic has a long history of providing first-rate, patient-centered healthcare. With more than 450 physicians and allied health professionals practicing at 24 locations in the Greater Houston area, Kelsey-Seybold’s model of coordinated care is embraced by more than 500,000 patients who have made the Clinic their healthcare provider of choice.

In 2012, in the Clinic was the first medical organization in the United States accredited as an “Accountable Care Organization” by the prestigious National Committee for Quality Assurance (NCQA). Kelsey-Seybold also owns and operates “Kelsey-Care Advantage,” a Medicare Advantage plan which has received the coveted 5-star quality designation by the Centers for Medicare & Medicaid Services (CMS).

In addition to operating Texas’ largest ambulatory surgery center, the Clinic provides an accredited Sleep Center, comprehensive laboratory services, advanced imaging and diagnostics, 16 onsite Kelsey pharmacies, and partners with major insurers to offer value-based commercial health plans.

The Role

Kelsey – Seybold currently offers three different types of health plans: 1. Commercial (B2B) which sells Kelsey health plans, offered by each of the major insurance carriers, to employers; 2. KelseyCare Medicare Advantage (B2C) which provides Medicare Advantage Plans directly to consumers; and 3. Fee for Service for direct payment from patients.

To support continued growth, Kelsey – Seybold is seeking to hire a new Sr. Director of Risk Adjustment to take responsibility for the leadership, direction, and operational support of Kelsey’s Risk Adjustment Program. The Director will work in close collaboration and partnership with the Medical Director of Risk Adjustment to plan, organize, and implement processes in support of business teams and physician partners. The new leader will report to the VP of Managed Analytics and lead a team of 20 with around 5 direct reports. The role may be based at company headquarters in Houston, TX or remote.

Experience & Requirements

• At least 10 years of professional experience in CMS risk adjustment
• 5+ years in supervisory capacity, preferably at the Director level, with managed care/health insurance industry experience as well as strong knowledge of ICD-10 coding requirements and regulations preferred
• Familiarity with EpicCare Ambulatory and Healthy Planet, including BPA and Registries
• Ability to travel to clinic sites as needed
• Proven track record in managing major projects and/or programs
• Familiarity with Medicare guidelines and CMS regulations
• Demonstrated ability to work cross-functionally with internal and external stakeholders
• Business acumen and presence required to build credible relationships with VP and C-Suite level clients; polished presence and communication skills, written and verbal
• A flexible, dynamic, self-demanding and proactive individual; able to motivate him/herself and others

Application Information

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Additional Questions

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