Humana

Humana.

  • Arizona


  • Irreversible.

  • Full-time.

Description

Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional

Our search is concentrated on determining a private factor who will work carefully with service providers to determine documents and coding enhancement chances and offer assistance around functional and medical finest practices in the danger change approach. This function reports to the Risk Adjustment Director and will work carefully with market operations, financing and medical group to successfully affect a service provider to embrace finest practices in the threat change method.

Responsibilities

Sr Medicare Risk Adjustment Coding & Documentation Improvement Professional

Our search is concentrated on recognizing a specific factor who will work carefully with suppliers to determine paperwork and coding enhancement chances and offer assistance around functional and medical finest practices in the threat modification approach. This function reports to the Risk Adjustment Director and will work carefully with market operations, financing and scientific group to successfully affect a service provider to embrace finest practices in the threat modification approach. The effective prospect will have comprehensive, extensive and broad understanding of the HCC threat modification approach got from real experience of persistent condition paperwork and coding audits, threat change program application and service provider education shipment. In addition, the prospect can show effective efficiency of a range of challenging projects, frequently utilizes brand-new innovations, theories, principles and uses sophisticated understanding/ experience in own location to effect other locations of organization. He/she can make suggestions including other functions and other service systems based upon sophisticated knowledge/experience. A perfect prospect will likewise have the capability to take a look at service provider efficiency metrics and be able recognize where the danger modification spaces exist and how to close them with readily available resources. This function is anticipated to create an action strategy and impact group adoption by efficiently engaging service providers and functional leaders, manage its execution and display results. This likewise needs a dedication to cultivating internal and external company relationships to accomplish wanted results. A perfect prospect will be acknowledged for exceptional spoken, visual and written interaction abilities, strong analytical abilities, capability to handle contending top priorities, and attention to information.

Work will need 50% travel regionally as required.

Actual role function examples:

  • Develop a detailed understanding of Humana’s danger change programs and the resources needed for effective application
  • Develop and use eager insight of our companies and our KPIs, and have the ability to tactically examine where enhancements can be made in the most reliable method with offered resources
  • Perform analysis of efficiency indications and created an official discussion for reporting out to suppliers on a frequently arranged basis
  • Provide quantifiable, actionable options to companies that will lead to enhanced precision of documents and coding, and adoption of finest practices
  • Build a strong collective relationship with our internal partners to set the phase for effective engagement of our supplier groups
  • Successfully carry out determined strategy to successfully affect danger change due dates and report on development frequently
  • Assist suppliers in comprehending the CMS – HCC Risk Adjustment program as a payment method and the significance of correct chart paperwork
  • Monitor KPIs through analytics and recognize service providers for Medicare Risk Adjustment training, programs and documentation/coding resources
  • Provide ICD10 – HCC coding training to service providers and proper personnel
  • Facilitate coding discussions and training to big and little groups of clinicians, practice supervisors and licensed coders
  • Train doctors and other personnel relating to paperwork, billing and coding and offer feedback to doctors concerning documents practices and compliance with state and federal guidelines
  • Cultivate efficient collaborations in a matrix environment of coding teachers, medical director, medical and market operations
  • Lead efforts and options consisting of collaborating admin-related jobs
  • Facilitate, track and pattern for reporting to management and taking part groups and have the ability to make suggestions for enhancement
  • Performs other pertinent tasks considered essential to accomplish department and company-wide objectives

Requirements:

  • Bachelor’s Degree or comparable experience
  • At least 3 years of experience in threat change coding/auditing/education and company relations/engagement
  • Experience in management position is chosen; experience acquired in threat change field in doctor practice or supplier group is a plus
  • Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or desire to get right after hire
  • Prior experience in effectively engaging with service providers to take part in efficiency enhancement programs
  • In-depth understanding of danger change crucial efficiency signs
  • Prior experience operating in a cross-functional group
  • Expert assistance and discussion abilities to consist of online shipment (Webex)
  • Advanced Microsoft Office abilities consisting of Word, Excel, Outlook and PowerPoint
  • Demonstrated capability to handle contending top priorities and to successfully handle tasks at the same time
  • Demonstrated capability to adjust rapidly to alter
  • Knowledge of EMR
  • Advanced understanding of billing/ claims submission and other associated functions
  • Willingness and capability to take a trip at a rate of roughly 50% over night throughout New Mexico, Arizona and Colorado as required
  • Associates operating in the state of Arizona need to abide by the Tobacco Free Hiring Policy (see information listed below under Additional Information) and upon deal will undergo nicotine screening as part of a 10- panel drug test
  • This function belongs to Humana’s Driver security program and for that reason needs a specific to have a legitimate state chauffeur’s license and evidence of individual automobile liability insurance coverage with a minimum of 100/300/100 limitations
  • We will need

for this task as we are a health care business dedicated to putting health and wellness initially for our members, clients, partners and the neighborhoods we serve. If advanced to use, you will be needed to offer evidence of complete vaccination or paperwork for a medical or spiritual exemption factor to consider where permitted by law. Ask for these exemptions ought to be sent a minimum of 2 week prior to your arranged very first day of work.

This is a work at house position however needs as much as 50% travel throughout the states of New Mexico, Arizona and Colorado to consult with suppliers as required. You will be needed to go to departmental/team conferences sometimes at our Phoenix or Centennial workplaces.

Scheduled Weekly Hours

40

Colorado Pay Range

The settlement variety represents a good-faith price quote of annualized beginning pay at the time of publishing based upon a full-time 40- hour workweek and might differ based upon geographical area and/or work type. Specific pay choices will differ based upon shown occupational abilities such as education, experience, accreditations, and so on

74,900-103,175

Pay Type Hourly

Incentive This task is qualified for a benefit reward strategy. This reward chance is based upon business and/or specific efficiency.

Description of Benefits Humana, Inc. and its associated subsidiaries (jointly, “Humana”) provides competitive advantages that support whole-person wellness. Associate advantages are created to motivate individual health and wise health care choices for you and your household while likewise understanding your life extends beyond work. Amongst our advantages, Humana supplies medical, oral and vision advantages, 401( k) retirement cost savings strategy, time off (consisting of paid time off, business and individual vacations, volunteer time off, paid adult and caretaker leave), short-term and long-lasting special needs, life insurance coverage and lots of other chances.

Humana.

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