Humana Medicare Risk Adjustment Director in Metairie, Louisiana

Role:Medicare Risk Adjustment Director

Assignment:Market Management – Gulf States Region

Location:New Orleans, LA

Assignment Capsule

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.

Primary Responsibilities:

  • 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

Role Essentials

  • 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

  • Bachelor’s degree

  • 3 years of experience working in or with Risk Adjustment

  • Proficient in MS Office (including Excel Pivot tables and functions, PowerPoint and Word)

    Preferred Qualifications:

  • Master’s degree (in Business, Healthcare or relevant field)

  • Experience working with mid or large-sized physician practices and or hospitals

    Reporting Relationships

    You will report to the Regional President

Title: Medicare Risk Adjustment Director

Location: Louisiana-Metairie

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.