This role reports to SCIO/ EXL VP Risk Adjustment/Quality Reporting and is focused on effectively partnering with customers to deliver digital solutions that help to optimize risk adjustment, documentation accuracy, provider and network performance, and quality outcomes for the populations that they manage.
The SCIO/EXL solutions focus on population benchmarking for disease prevalence, risk stratification and risk adjustment, cost, utilization, quality, provider and network performance, and value and outcomes reporting. SCIO provides additional services that target the analysis and improvement of documentation and coding accuracy for risk adjustment and payment integrity, specifically targeted to value-based payment contracts. Additional services include analytic tools and services that support member engagement, care operations, quality measurement, and consumer analytics across health plans, providers, care and wellness companies and large employers.
As SCIO/EXL's solutions are designed to assist customers to operationalize effective analytic programs within the client environment, this position will strategically focus on the integration of analytical output into their digital environment, including EHRs, data warehouses, population health, and consumer-facing health systems.
The scope of the role includes the following functions: Pre-sales Support engage with Sales in developing a prospect specific approach leveraging SCIOs core analytics and technology offerings. Coordinate all aspects of pre-sales engagement through to contract. Perform system demonstrations detailing the benefits of the SCIO health Analytics solutions. Develop and deliver client demonstration stories that are appropriate for each client type and persona. Delivery Coordination in partnership with Client Engagement team, assure on time and on budget delivery of solutions as scoped. Acting in the capacity of industry expert, imparting knowledge of best practices during implementations. Solution Design ideation, design, and optimization of SCIO analytics-as-a-service and software-as-a-service offerings. Professional Services deploy, and manage client facing, revenue generating professional services. Domain Expertise serve as primary resource to SCIO organization on contemporary industry and market trends. In partnership with Marketing, develop and support thought leadership platform.
Responsibilities Manage the client-facing engagement program for RQM clients. This position will represent SCIO/EXL as a client-facing industry subject matter expert including; RQM analytics, products and services. Work with Sales, Marketing, Client Engagement, Analytics, and Technology departments to ensure, document, and communicate customer success. Work across SCIO stakeholders to ensure achievement of SCIOs business goals and objectives; including focused growth of the business unit. Manage other client engagement personnel in the prioritization of client deliverables including client communication, planning, and identifying operational process flow; ability to plan, manage and execute projects within targeted time and budget. Must own the customer-facing delivery of the service (including design, packaging, development, delivery, feedback, etc.) and monitor issues through to resolution. Develop positive working relationships with all the departments. Work with Sales and Account managers to develop specific client solutions based on client needs and SCIO/EXLs products and services including scope of work, customization requirements, timelines, pricing. Further the solution experts will bring in experts from data, technology and advanced analytics teams as necessary to develop the solutions.
Required 10+ years of healthcare or clinical information technology experience, with at least 7 years within the RQM space Advanced knowledge of risk and quality management healthcare and industry trends, including healthcare clinical data standards, current integration, interoperability methodologies and technologies, as well as knowledge of the vendor market that provides related services Proven track record delivering healthcare information technology solutions within a customer-facing role Expertise with the delivery of services related to product and technology solutions to solve healthcare-related business problems Expertise in health care data analysis to drive cost, utilization and quality recommendations for clients Experience with healthcare industry quality measures and quality reporting requirements (e.g., NQF, CQM, PQRS, HEDIS, Stars, etc.) NCQA-certification highly desired Expert-level client management, project and implementation management experience especially Excellent communication and presentation skills -- oral and written Experience working with healthcare data including clinical and transactional data standards and codes used within EHRs, PHRs, Medical and Pharmacy claims to facilitate integration/interoperability and/or transmission to other systems. These include, but are not limited to CMS data (MMR, MOR, MAOO2, MAOO4 files), claims data (837, ASM, CCLF, CDA files), terminologies and interface standards (ICD, CPT, HCCs, SNOMED, LOINC, NCPDP, Continua, RxNorm, NDC) and so forth. Critical ability to think through new and unique product and service solutions and provide recommendations to customers and prospects that solve real business problems Knowledge of Population Management, Risk Adjustment, as well as various Care, Disease, Wellness Management interventions Knowledge of healthcare payment industry, especially related to value-based contracts Knowledge of medical record and claims auditing for risk adjustment, financial recovery and/or overpayment avoidance
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