CLevelCrossing
AVP MD Stars and Risk Adjustment Clinical Strategy and Leadership
CLevelCrossing, Minneapolis, Minnesota, United States, 55400
AVP MD Stars and Risk Adjustment Clinical Strategy and Leadership
Location:
Minneapolis, MN, United StatesPosted on:
Dec 17, 2022ProfileThe Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead its Provider Support team and associate's responsibilities. HQRI is an organization with over 900 associates that leads Humana's Stars and Risk Adjustment Strategy, operations, and performance nationally.The Associate VP for Healthcare Quality Reporting and Improvement (HQRI) relies on medical background and industry-standard clinical/coding guidance to ensure physician and healthcare provider education, reporting and materials are accurate and consistent across the enterprise to support regional and corporate strategic initiatives.Responsibilities:Lead the HQRI Provider Support Team in collaboration with key corporate stakeholders and regional teams.Provide ongoing training, reporting, tools, and programs to support corporate and regional strategies for physician and healthcare provider education for Risk Adjustment and Stars.Provide supportive clinical and coding expertise across the teams in HQRI.Serve as HQRI's clinical industry representative (e.g., conferences, national vendor or provider partners).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 on accurate reporting; Provider communications; policies and procedures aligned to those functions.Serve as a coding expert, including working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates.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 maintaining accuracy of coding and documentation to capture the true health status of our members through risk adjustment initiatives.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.Experience in external communications for physicians and healthcare providers.Prior experience leading teams focusing on the accuracy of medical record documentation and diagnosis coding.Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.Working knowledge of risk adjustment concepts.Clinical specialty in Internal Medicine, Family Practice, Geriatrics, OBGYN, or Hospitalist.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 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:
40Humana 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.
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Location:
Minneapolis, MN, United StatesPosted on:
Dec 17, 2022ProfileThe Healthcare Quality Reporting & Improvement (HQRI) organization is seeking an AVP to lead its Provider Support team and associate's responsibilities. HQRI is an organization with over 900 associates that leads Humana's Stars and Risk Adjustment Strategy, operations, and performance nationally.The Associate VP for Healthcare Quality Reporting and Improvement (HQRI) relies on medical background and industry-standard clinical/coding guidance to ensure physician and healthcare provider education, reporting and materials are accurate and consistent across the enterprise to support regional and corporate strategic initiatives.Responsibilities:Lead the HQRI Provider Support Team in collaboration with key corporate stakeholders and regional teams.Provide ongoing training, reporting, tools, and programs to support corporate and regional strategies for physician and healthcare provider education for Risk Adjustment and Stars.Provide supportive clinical and coding expertise across the teams in HQRI.Serve as HQRI's clinical industry representative (e.g., conferences, national vendor or provider partners).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 on accurate reporting; Provider communications; policies and procedures aligned to those functions.Serve as a coding expert, including working through escalations on coding disputes, policy development or refinement, and coordination and education with providers or Humana associates.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 maintaining accuracy of coding and documentation to capture the true health status of our members through risk adjustment initiatives.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.Experience in external communications for physicians and healthcare providers.Prior experience leading teams focusing on the accuracy of medical record documentation and diagnosis coding.Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.Working knowledge of risk adjustment concepts.Clinical specialty in Internal Medicine, Family Practice, Geriatrics, OBGYN, or Hospitalist.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 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:
40Humana 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.
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