Manager Risk Adjustment Coding Education

Profile

Description

Manages a team of coding educators and reports to Risk Adjustment Director. Responsible for implementing operational and clinical best practices in the risk adjustment methodology, understanding clinical suspects and appropriate clinical documentation and accurate coding. As a member of the MRA team, the Manager will work closely with market operations, finance and clinical teams to effectively look at provider performance metrics and 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. The Manager, Risk Adjustment works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.The Manager, Risk Adjustment conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Manager, Risk Adjustment works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Job Responsibilities include:

Responsibilities

Manage team of coding educators including day-to-day oversight and performance reviews

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

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

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

Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area.

Maintains frequent contact with other managers across the department and with department director.The Manager, Risk Adjustment ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. May participate in provider education programs on coding compliance. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

Required Qualifications

CPC (Certified Professional Coder) Certification or equivalent required

Bachelor's Degree or equivalent experience

At least 5 years of experience in risk adjustment coding/auditing/education and provider relations/engagement or equivalent experience

Prior experience in successfully engaging with providers to participate in performance improvement programs

Previous experience working in a managed care field

In-depth knowledge of risk adjustment key performance indicatorsPrior experience working in a cross-functional teamExpert facilitation and presentation skills to include online delivery (Webex)

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

Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Travel required, up to 25% of the time

According to Humana's COVID-19 policy, vaccination and masking is required regardless of vaccination status (with exception for eating and drinking) for associates working in a clinical setting where patients receive care (e.g., pharmacy retail locations, clinics, home care). The policy only requires the primary series alone (first and second vaccine). Boosters are encouraged, but not required. Associates have the option to request an accommodation for medical, religious or other personal needs.

Preferred Qualifications

Graduate degree

CPC-I, CRC or CPMA strongly preferred

Progressive business consulting and/or operational leadership experience

Proficiency in analyzing and interpreting data trends

Comprehensive knowledge of Medicare policies, processes and procedures

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability

Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire Screen. You should anticipate this screen to take about 15 to 30 minutes. Your screen will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

This is a remote position

#LI-Remote

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay at the time of posting in Torrance, California. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$0 - $0This 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

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