CLevelCrossing
AVP MD Stars and Risk Adjustment Clinical Strategy and Leadership
CLevelCrossing, Atlanta, Georgia, United States, 30383
AVP MD Stars and Risk Adjustment Clinical Strategy and Leadership
Location:
Atlanta, GA, United StatesPosted on:
Dec 17, 2022ProfileHumana is seeking an AVP to lead its Provider Support team within the Healthcare Quality Reporting & Improvement (HQRI) organization. This role is pivotal in guiding Humana's Stars and Risk Adjustment Strategy, operations, and performance nationally.The Associate VP relies on a medical background and industry-standard clinical/coding guidance to ensure accurate and consistent physician and healthcare provider education, reporting, and materials across the enterprise to support strategic initiatives.ResponsibilitiesLead 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 HQRI teams.Serve as HQRI's clinical industry representative at conferences and with 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, Provider communications, and policies and procedures.Serve as a coding expert, addressing escalations on coding disputes, policy development, and coordination with providers or Humana associates.Required QualificationsMD 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 in coding and documentation to capture the true health status of 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.External communications experience for physicians and healthcare providers.Prior experience leading teams focusing on medical record documentation and diagnosis coding accuracy.Medical management experience with health insurance organizations, hospitals, and other healthcare providers.Working knowledge of risk adjustment concepts.Experience in Internal Medicine, Family Practice, Geriatrics, OBGYN, or Hospitalist clinical specialties.Detail-oriented and effective listener.Experience with Stars, including HEDIS, CAHPS, and HOS.Prior experience in a business function or business consulting role.Additional InformationHumana 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:
Atlanta, GA, United StatesPosted on:
Dec 17, 2022ProfileHumana is seeking an AVP to lead its Provider Support team within the Healthcare Quality Reporting & Improvement (HQRI) organization. This role is pivotal in guiding Humana's Stars and Risk Adjustment Strategy, operations, and performance nationally.The Associate VP relies on a medical background and industry-standard clinical/coding guidance to ensure accurate and consistent physician and healthcare provider education, reporting, and materials across the enterprise to support strategic initiatives.ResponsibilitiesLead 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 HQRI teams.Serve as HQRI's clinical industry representative at conferences and with 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, Provider communications, and policies and procedures.Serve as a coding expert, addressing escalations on coding disputes, policy development, and coordination with providers or Humana associates.Required QualificationsMD 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 in coding and documentation to capture the true health status of 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.External communications experience for physicians and healthcare providers.Prior experience leading teams focusing on medical record documentation and diagnosis coding accuracy.Medical management experience with health insurance organizations, hospitals, and other healthcare providers.Working knowledge of risk adjustment concepts.Experience in Internal Medicine, Family Practice, Geriatrics, OBGYN, or Hospitalist clinical specialties.Detail-oriented and effective listener.Experience with Stars, including HEDIS, CAHPS, and HOS.Prior experience in a business function or business consulting role.Additional InformationHumana 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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