1+ months

Director, Risk Adjustment

Humana
Cary, NC 27512
Description The Director, Risk Adjustment conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Director, Risk Adjustment requires an in-depth understanding of how organization capabilities interrelate across the function or segment. Responsibilities The Director, Risk Adjustment ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. May participate in provider education programs on coding compliance. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy. The core functions for this role are: + Evaluation and analysis of Medicare Risk Adjustment opportunities + Education collaboration with treating physicians and the internal colleagues who support them. + Designing and executing a plan for chart retrieval and coding. Major Duties and Responsibilities: + Education and presentation to physician groups at risk meetings + Facilitate decision-making with regional and corporate leadership based on strategic and tactical recommendations for program improvement + Build and maintain a cohesive and talented team by establishing clear direction, goals and responsibilities + Direct and manage all regionally-based risk adjustment activities + Work cross-functionally to establish risk adjustment analytics such as predictive modeling for coding improvement opportunities, provider coding performance, risk score trending and tracking, and transfer payment accruals + Optimize business performance by coordinating with internal and corporate partners for all related business purposes + Work with the finance team to identify and target providers for additional training on improving documentation, strengthening coding practices and ensuring coding accuracy + Understand Humanas market position within the region and remaining current with Medicare industry developments and the evolving regulatory environment + Assuring all regional MRA functions and Humana activities are in compliance with relevant CMS regulations Required Qualifications + Bachelor's degree: Nursing; or an Advanced Medical Degree + 5+ yrs experience working in a healthcare leadership role + Proven ability to function effectively in matrix management environment and as a member of an interdisciplinary team + 3+yrs of MRA experience + Ability to communicate with clinicians and all levels of management. + Direct leadership experience and demonstrated ability to lead, coach and mentor teams. + Proficient in MS Office (including Excel Pivot tables and functions, PowerPoint and Word) + Excellent communication skills, both orally and written, among all levels of the organizational hierarchy; including being able to present confidently and review reports and insights with external clinicians. + Ability to enhance process improvement and create, implement and execute protocols and procedures. + A high level of engagement and emotional intelligence, committed to making a difference through, innovative thought & strategic thinking + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Candidate must reside in the Richmond, VA or Cary, NC area or have the ability to commute. Preferred Qualifications + Master's Degree in Healthcare + Experience working with mid or large-sized physician practices and or hospitals CPC (Certified Professional Coder) Additional Information Role will require 25% travel, and occasional overnight travel out of state Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

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Posted: 2020-01-22 Expires: 2020-03-22

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Director, Risk Adjustment

Humana
Cary, NC 27512

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