Manager Medicare Risk Adjustment - Remote

Profile

Description

The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). 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.

Responsibilities

The Manager, Risk Adjustment oversees coding accuracy and the risk adjustment programs of the providers in the Mid Atlantic region.

Leads a team of up to 11 Coding Educators and Risk Adjustment Professionals

Works with Senior Leadership, Corporate Risk Adjustment, and other Regional Risk Adjustment members, as well as Providers and Health Systems throughout the Mid Atlantic Region

Develops Provider Coding Education strategies and procedures for Mid Atlantic providers

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

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 leaders across the region

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

Medical Benefits

Dental Benefits

Vision Benefits

Health Savings Accounts

Flex Spending Accounts

Life Insurance

401(k)

PTO including 7 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time

And more

Required Qualifications

CPC (Certified Professional Coder) Certification

3 years of coding experience

1 years of formal or informal supervisory experience

Previous experience working in a managed care field

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

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

CPC-I, CRC or CPMA certification

Risk adjustment experience

Strong knowledge of ICD-9/10 diagnosis codes

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

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Work at Home/Remote Requirements

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m (satellite and/or wireless internet connections are NOT permitted for Work at Home roles) and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process. #ThriveTogether #WorkAtHome

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Humana is more than an equal opportunity employer, Humana's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful.

#LI-LM1

Scheduled Weekly Hours

40

Company info

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