Senior Medicare Risk Adjustment/Documentation & Coding Professional
5+ yearsSenior Medicare Risk Adjustment/Documentation & Coding Professional:
This position can be located in our Phoenix AZ or Albuquerque NM office.
Our search is focused on identifying an individual contributor who will take ownership of Medicare risk adjustment programs that fit best with our providers by implementing operational and clinical best practices in the risk adjustment methodology, understanding clinical suspects and appropriate clinical documentation and accurate coding. This role reports to the MRA Director and as a member of the MRA team will work closely with market operations, finance and clinical team to effectively match the right program to Value-based groups, put together an action plan, influence group adoption, implement, monitor and effectively engage providers and operational leaders. The successful candidate will possess extensive in-depth or broad knowledge of the HCC risk adjustment methodology gained from actual experience of HCC documentation and coding audits, 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 includes a commitment to cultivating internal and external business relationships to achieve agreed-upon results. An ideal candidate will be recognized for excellent verbal, visual and written communication skills, strong analytical skills, ability to manage competing priorities, and attention to detail.
Work will require 50% travel regionally as needed.
Actual role function examples:
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 puts 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
Project manage prospective programs and solutions including coordinating admin-related tasks
Facilitate, track and trend programs and solutions for reporting to leadership and participating groups and be able to make recommendations for improvement
Performs other relevant duties deemed necessary to achieve department and company-wide goals
Requirements:
Bachelor’s Degree or equivalent experience
At least 5 years of experience in risk adjustment coding/auditing/education and provider relations/engagement
Experience in management position is preferred; experience gained in risk adjustment field or physician practice is a plus
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 (Webex)
Advanced Microsoft Office skills including Word, Excel, Outlook and PowerPoint
Demonstrated ability to manage competing priorities and to effectively manage projects simultaneously
Demonstrated ability to adapt quickly to change
Knowledge of EMR
Advanced knowledge of billing / claims submission and other related functions
Willingness and ability to travel at a rate of approximately 50% overnight throughout New Mexico, Arizona and Colorado as necessary
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test
This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
CONTACT: cfusella@humana.com
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