AVP Stars and Risk Adjustment National Medical Director
Location: Birmingham, AL, 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. This role will carry individual contributor and leadership responsibilities.
Responsibilities
- Inform and support HQRI's provider strategy across Stars, RA, and Interoperability.
- Serve as a coding expert to manage escalations or establish compliant policies.
- Contribute as a clinical industry representative.
- Lead HQRI's Provider Support team (PST) that drives national provider education strategy and operations.
This role relies on medical background, business acumen, and industry-standard clinical/coding guidance to ensure physician and healthcare provider plans, education, reporting, and materials are accurate and consistent across the enterprise to support regional and corporate strategic initiatives.
Major Responsibilities
- Inform HQRI's provider strategy and increase adoption of Humana's Stars, MRA, and interoperability strategy and programs.
- Lead a team of 10 associates across three functions: Education of Humana's Market-based associates, Provider communications, and policies and procedures.
- Serve as HQRI's clinical industry representative.
- Serve as a coding expert, working through escalations on coding disputes, policy development, and provider education.
Required Qualifications
- MD or DO degree.
- A current and unrestricted license in at least one jurisdiction.
- Board Certified in an approved ABMS Medical Specialty.
- Excellent communication skills, both written and verbal.
- 5 years of established clinical experience.
- Knowledge of the managed care industry including Medicare, Medicaid, and/or Commercial products.
- Passionate about healthcare quality and coding accuracy.
- Experience with quality assurance and/or regulatory compliance.
- Travel up to 25%.
Preferred Qualifications
- Certification in diagnosis coding (must receive AAPC certification within one year of hire).
- Ability to develop and use data and analytics to drive sustainable results.
- Prior experience leading teams focusing on medical record documentation and diagnosis coding.
- Medical management experience with health insurance organizations, hospitals, and other providers.
- Working knowledge of risk adjustment concepts.
- Detail oriented and effective listener.
- Experience with Stars, including HEDIS, CAHPS, and HOS.
- Prior experience in a business function or business consulting role.
Additional Information
Vaccine Policy: Humana requires 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 based on race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. We also provide free language interpreter services.
Humana Inc.
Website: http://www.humana.com
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