AVP Stars and Risk Adjustment National Medical Director

AVP Stars and Risk Adjustment National Medical Director

Employment Type : Full-Time

All potential candidates should read through the following details of this job with care before making an application.

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.

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.

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, policies, and procedures.
• Serve as HQRI's clinical industry representative.
• Serve as a coding expert, working through escalations on coding disputes and policy development.

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 maintaining accurate 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 develop and use data and analytics to drive sustainable results.
• Prior experience leading teams focusing on medical record documentation and coding accuracy.
• Medical management experience with health insurance organizations and 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 :

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.

J-18808-Ljbffr