Chartway Credit Union is hiring: Multimedia Designer Job at Chartway Credit Unio

AVP Stars and Risk Adjustment National Medical Director

Location : Sandy, UT, United States

Employment Type : Full-Time

Posted on : Apr 28, 2023

Profile

The Healthcare Quality Reporting & Improvement (HQRI) organization is seeking a talented Physician executive that can contribute to Humana's national planning and operations for Risk Adjustment, Stars, and Interoperability. Specifically, this role will carry a set of individual contributor and leadership responsibilities.

Responsibilities

1. Inform and support HQRI's provider strategy across Stars, RA, and Interoperability.
2. Serve as a coding expert to manage escalations or establish compliant policies.
3. Contribute as a clinical industry representative.
4. Lead HQRI's Provider Support team (PST) that drives national provider education strategy and operations.
5. Ensure physician and healthcare provider plans, education, reporting, and materials are accurate and consistent across the enterprise.

Major responsibilities include :

1. Inform HQRI's provider strategy and increase adoption of Humana's Stars, MRA, and interoperability strategy and programs.
2. Lead a team / organization of 10 associates across three functions: Education of Humana's Market-based associates, Provider communications, policies, and procedures.
3. Serve as HQRIs clinical industry representative (e.g., Conferences; national vendor or provider partners).
4. Serve as a coding expert, which may include working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates.

Required Qualifications

1. MD or DO degree.
2. A current and unrestricted license in at least one jurisdiction.
3. Board Certified in an approved ABMS Medical Specialty.
4. Excellent communication skills, both written and verbal.
5. 5 years of established clinical experience.
6. Knowledge of the managed care industry including Medicare, Medicaid, and/or Commercial products.
7. Must be passionate about healthcare quality and contributing to an organization focused on maintaining accuracy of coding and documentation.
8. Experience with quality assurance and/or regulatory compliance.

Preferred Qualifications :

1. Certification in diagnosis coding (must receive AAPC certification within one year of hire).
2. Ability to help develop and use data and analytics to drive sustainable results.
3. External communications for physicians and healthcare providers.
4. Prior experience leading teams focusing on the accuracy of medical record documentation and diagnosis coding.
5. Medical management experience, working with health insurance organizations, hospitals, and other healthcare providers.
6. Working knowledge of risk adjustment concepts.
7. Detail oriented and effective listener.
8. Experience with Stars, including HEDIS, CAHPS, and HOS.
9. Prior experience in a business function or business consulting role.

Additional Information :

Vaccine Policy : 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.

Scheduled Weekly Hours : 40

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.