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The Associate Vice President (AVP) Encounters Submissions is responsible for the integrity, accuracy, and timeliness of submitting encounter data to Centers for Medicare and Medicaid Services (CMS) and/or Medicaid State Agencies for all Medicare, D-SNP, and Medicaid contracts. The AVP is accountable for working collaboratively across the enterprise and with multiple external partners to ensure robust processes, procedures, analytics, and technology capabilities are implemented to achieve critical compliance requirements

The Associate Vice President Encounters Submissions leads a large-scale operation of ~220 associates focused on the successful submission of encounters data to CMS and Medicaid State Agencies.  The AVP will be responsible for driving all operational activities required to achieve CMS and state specific metrics - to include submission timeliness and accuracy, rate setting, kick payments, and audit-related requirements Success in this role includes building a strong culture of teamwork, accountability, process improvement, innovation, and compliance.

Responsibilities:

• Ensures encounter data submissions continuously meet or exceed all compliance and operational standards/requirements.
• Accountable for operational implementation of new Medicaid and D-SNP contracts’ encounters submissions.  Partners with Corporate Medicaid to support RFP process for Medicaid state expansions. Includes proactive communication and escalation of requirements that create operational challenges. 
• Leads/influences across all levels of the enterprise to develop and implement a transformational 5-year strategy.
• Fosters trusted relationships with enterprise partners to ensure end-to-end processes are optimized and communications/escalations occur timely and effectively.
• Product ownership of multiple systems/platforms in collaboration with IT leadership, business technology and analytics teams, and external vendors.
• Communicates to senior leaders (SVP+) regularly on operational performance, risks, and opportunities. 
• Continuously identifies and implements levers for risk mitigation, improved control environment, and cost optimization.
• Build a strong culture of teamwork, accountability, process improvement and efficiency, and compliance mindset to drive overall team success and engagement

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree
• Medicare Advantage/ Medicaid-specific industry knowledge and experience
• 7+ years of management experience
• 3+ years of experience managing large-scale operational processes with ambitious compliance standards
• Demonstrated outcomes implementing process reengineering, automation, advanced analytics, and technology stacks to achieve operational excellence.
• Experience optimizing processes via a robust control environment
• Enterprise-thinker who can drive innovation outside of silos
• Best in class communication skills; ability to educate and influence executive level (SVP+) leaders
• Demonstrated experience in leading large organizations while optimizing organizational design and infusing talent development best practices.
• Comfort making quick decisions based on quantitative and qualitative insights
• Experience managing critical vendor relationships and standing up new vendor contracts/capabilities

Preferred Qualifications

• Master’s degree in business, technology, or a related field
• Preference will be given to those is eastern time zone.
• Experience managing large production-oriented teams
• Experience in claims processing, encounters submissions, or Risk Adjustment
• Experience with the IT budgeting and prioritization process
• Experience communicating with regulatory bodies

Location: Preference will be given to candidates residing in Central or Eastern time zones. Preferred location is Louisville, KY where most of the team resides.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

 

$203,400 - $279,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performan