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The Senior Risk Adjustment Administration Professional will work closely with providers to identify documentation and coding improvement opportunities and give guidance around operational and clinical best practices in the risk adjustment methodology. This role reports to the Risk Adjustment Manager and will work closely with market operations, finance and clinical team to effectively influence a provider to adopt best practices in the risk adjustment methodology. The successful candidate will possess extensive, in-depth and broad knowledge of the HCC risk adjustment methodology gained from actual experience of chronic condition documentation and coding audits, risk adjustment program implementation and provider education delivery. In addition, the candidate can demonstrate successful performance of a variety of difficult assignments, regularly uses new technologies, theories, concepts and applies advanced knowledge/ experience in own area to impact other areas of business. He/she can make recommendations involving other functions and other business units based on advanced knowledge/experience. An ideal candidate will also have the ability to look at provider performance metrics and be able identify where the risk adjustment gaps exist and how to close them with available resources. This role is expected to put together an action plan and influence group adoption by effectively engaging providers and operational leaders, oversee its implementation and monitor outcomes. This also requires a commitment to cultivating internal and external business relationships to achieve desired outcomes.
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- Develop a comprehensive understanding of Humana's risk adjustment programs and the resources required for successful implementation.
- Develop and apply keen insight of our providers and our KPIs, and be able to strategically assess where improvements can be made in the most effective way with available resources.
- Perform analysis of performance indicators and put together a formal presentation for reporting out to providers on a regularly scheduled basis.
- Provide measurable, actionable solutions to providers that will result in improved accuracy of documentation and coding, and adoption of best practices.
- Build a strong collaborative relationship with our internal partners to set the stage for successful engagement of our provider groups.
- Successfully implement identified course of action to effectively impact risk adjustment deadlines and report on progress regularly.
- Assist providers in understanding the CMS - HCC Risk Adjustment program as a payment methodology and the importance of proper chart documentation.
- Monitor KPIs through analytics and identify providers for Medicare Risk Adjustment training, programs and documentation/coding resources.
- Provide ICD10 - HCC coding training to providers and appropriate staff.
- Facilitate coding presentations and training to large and small groups of clinicians, practice managers and certified coders.
- Train physicians and other staff regarding documentation, billing and coding and provide feedback to physicians regarding documentation practices and compliance with state and federal regulations.
- Cultivate effective partnerships in a matrix environment of coding educators, medical director, clinical and market operations.
- Lead initiatives and solutions including coordinating admin-related tasks.
- Facilitate, track and trend for reporting to leadership and participating groups and be able to make recommendations for improvement.
Use your skills to make an impact
Required Qualifications
- Bachelor's Degree
- 5+ years of experience in risk adjustment coding/auditing/education and provider relations/engagement
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
- Prior experience in successfully engaging with providers to participate in performance improvement programs
- In-depth knowledge of risk adjustment key performance indicators
- Prior experience working in a cross-functional team
- Expert facilitation and presentation skills to include online delivery
- Advanced Microsoft Office skills including Word, Excel, Outlook and PowerPoint
- Knowledge of EMR
- Advanced knowledge of billing / claims submission and other related functions
- Demonstrated ability to manage competing priorities and to effectively manage projects simultaneously
- Demonstrated ability to adapt quickly to change
Preferred Qualifications
- Certified Risk Adjustment Coder (CRC)
- Certified Documentation Expert Outpatient (CDEO)
- Experience gained in risk adjustment field in physician practice or provider group is a plus
- Preference for candidates to reside in Arizona, Colorado, or New Mexico and/or have the ability to accommodate a work schedule following Pacific/Mountain time zone hours
Additional Information
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
WAH / Internet Information:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
SSN Alert: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$76,800 - $105,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.