Role:Medicare Risk Adjustment Director
Assignment:Market Management – Gulf States Region
Location:New Orleans, LA
Humana is seeking a Medicare Risk Adjustment Director to provide leadership that combines broad vision with a critical eye for internal operations and quality assurance. As a member of the Gulf States Region leadership team, the Medicare Risk Director contributes to the Humana’s success by creating and executing on a comprehensive strategy to capture and improve upon the accuracy and specificity of the coding within our provider network.
Provide leadership and direction for all functions related to MRA education and coding for Louisiana and Mississippi
Three main areas of responsible and oversight include: analysis in determining MRA opportunity, education with external physician groups and design of plan for chart retrieval and coding
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 Humana’s 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
Progressive experience working in a healthcare setting, specifically within a Medicare Risk Adjustment organization or environment.
Demonstrated leadership skills and experience managing a team, particularly in a production type environment
Excellent verbal and written communication skills
Strong internal and external relationship-building skills
Experience with implementing policies and procedures while thinking strategically
3 years of experience working in or with Risk Adjustment
Proficient in MS Office (including Excel Pivot tables and functions, PowerPoint and Word)
Master’s degree (in Business, Healthcare or relevant field)
Experience working with mid or large-sized physician practices and or hospitals
You will report to the Regional President
Title: Medicare Risk Adjustment Director
Requisition ID: 191721
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.