Senior Risk Adjustment Professional - WAH AZ or CO

Profile

Description

The Senior Risk Adjustment Professional 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 Senior Risk Adjustment Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Risk Adjustment Professional 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. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Bachelor's Degree or 3 years of relevant experience

At least 5 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)

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 up to 75% throughout New Mexico, Arizona and Colorado as necessary

Preferred Qualifications

Master's Degree in Business Administration or a related field

Additional Information

This is a work at home position but requires up to 75% 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

Company info

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