Job Description

Description

o 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 Manager 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 providers, put together an action plan, implement, monitor and effectively engage providers and operational leaders. The successful candidate will have an advanced understanding of the HCC risk adjustment methodology gained from HCC documentation, coding and provider education experience. An ideal candidate will have the ability 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 above average communication skills, strong analytical skills, ability to manage competing priorities, and attention to detail. Work will require approximately 50% overnight travel throughout New Mexico, Arizona and Colorado as Develop a comprehensive understanding of Humanas risk adjustment programs and the resources required for successful implementation

Responsibilities

* 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
* Performs 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 developing training to fit specific provider's needs
* 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
* Performs other relevant duties deemed necessary to achieve department and company-wide goals

necessary.

Required Qualifications

* Associates Degree or equivalent experience
* Experience in the areas of provider relations, education and training of providers and medical office staff
* Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or willingness and ability to obtain either within 2 years of hire date
* Prior experience in successfully engaging with providers to participate in performance improvement programs
* Familiarity with risk adjustment key performance indicators
* Prior experience working in a cross-functional team; experience in management position in a physician practice is preferred
* Above average meeting facilitation and presentation skills to include online delivery (Webex)
* Intermediate to 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
* 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

Preferred Qualifications

* Bachelors Degree
* Any of the following certifications: CPC-I or RHIT

Above average meeting facilitation and presentation skills to include online delivery (Webex)

Additional Information

The following policy applies ONLY to associates working in the state of Arizona:

Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco

Scheduled Weekly Hours

40