Sr Medicare Risk Adjustment Coding amp Documentation Improvement Professional - WAH AZ or CO

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Job Information

Humana

Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional - WAH AZ or CO

in

Colorado Springs

Colorado

Description

Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional

Our search is focused on identifying an individual contributor who 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 Director 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.

Responsibilities

Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional

Our search is focused on identifying an individual contributor who 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 Director 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. 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 role is expected to put together an action plan and influence group adoption by effectively engaging providers and operational leaders, oversee its implementation and monitor outcomes. This also requires a commitment to cultivating internal and external business relationships to achieve desired outcomes. An ideal candidate will be recognized for outstanding 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 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

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

Lead initiatives and solutions including coordinating admin-related tasks

Facilitate, track and trend 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 3 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 in physician practice or provider group is a plus

Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or willingness to obtain soon after hire

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

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

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

This is a work at home position but requires up to 50% travel throughout the states of New Mexico, Arizona and Colorado to meet with providers as needed. Also you will be required to attend departmental/team meetings occasionally at our Phoenix or Centennial offices.

Scheduled Weekly Hours

40

Colorado Pay Range

The compensation range represents a good-faith estimate of annualized starting pay at the time of posting based on a full-time 40-hour workweek and may vary based on geographic location and/or employment type. Individual pay decisions will vary based on demonstrated job-related skills such as education, experience, certifications, etc.

74,900-103,175

Pay Type

Hourly

Incentive

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

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Company info

Humana Inc.
Website : http://www.humana.com