AVP Stars and Risk Adjustment National Medical Director
Location: Albany, NY, 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 carries 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.
- Ensure physician and healthcare provider plans, education, reporting, and materials are accurate and consistent.
Major Responsibilities Include:
- 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 (e.g., Conferences; national vendor or provider partners).
- Serve as a coding expert, working through escalations on coding disputes, policy development, and 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 accuracy of coding and documentation.
- 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 help 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 healthcare 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. Unvaccinated associates must undergo weekly negative COVID testing or wear a mask while in a Humana facility or 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. See our accessibility resources.
Humana Inc.
Website: http://www.humana.com
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