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The Senior Risk Adjustment Administration Professional will work closely with providers to identify documentation and coding improvement opportunities and give guidance around operational and clinical best practices in the risk adjustment methodology.

This role reports to the Risk Adjustment Manager and will work closely with market operations, finance and clinical team to effectively influence a provider to adopt best practices in the risk adjustment methodology.

The successful candidate will possess extensive, in-depth and broad knowledge of the HCC risk adjustment methodology gained from actual experience of chronic condition documentation and coding audits, risk adjustment program implementation and provider education delivery. 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 by putting together an action plan. This also requires a commitment to cultivating internal and external business relationships to achieve desired outcomes.

• 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 put 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.

• 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.

• Knowledge of EMR interoperability solutions to influence provider groups in population health management

• Facilitate presentations and train physicians and other staff regarding documentation, billing and ICD10 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.

• Facilitate, track and trend for reporting to leadership and participating groups and be able to make recommendations for improvement.

Use your skills to make an impact
 

Required Qualifications

• 5+ years of experience in risk adjustment coding/auditing/education and provider relations/engagement

• 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 and CMS payment models (V24 and V28)

• Prior experience working in a cross-functional team

• Expert facilitation and presentation skills to include online delivery

• Advanced Microsoft Office skills including Word, Excel, Outlook and PowerPoint

• Advanced knowledge of billing / claims submission and other related functions

• Demonstrated ability to manage competing priorities and to effectively manage projects simultaneously

• Demonstrated ability to adapt quickly to change

• Must work market designated time zone (Mountain or Pacific Time Zone)

Preferred Qualifications

• Bachelor’s Degree 

• Certified Risk Adjustment Coder (CRC)

• Certified Documentation Expert Outpatient (CDEO)

• Knowledge of EMR (Athena, Epic and eCW)

• Experience gained in risk adjustment field in physician practice or provider group

Additional Information

• Must work market designated time zone (Mountain or Pacific Time Zone)

Benefits Information:

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1

• Paid time off, holidays, volunteer time and j