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Associate VP, Risk Adjustment

Company: Centerwell
Location: Torrance
Posted on: November 18, 2022

Job Description:

DescriptionThe Associate VP, Risk Adjustment conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Associate VP, Risk Adjustment requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.ResponsibilitiesAs a senior-focused healthcare provider, and subsidiary of one the nation's leading integrated health companies, Humana, the Primary Care Organization puts the needs of seniors at the forefront of everything they do. The multidisciplinary team goes above and beyond to make centers a leading health and wellness destination for communities in key Medicare markets. The national primary care centers provide value-based care and represent nearly 200+ physician practices, 500 clinicians, 350,000 patients across 18 markets and $3B in annual revenue.As the nation's largest senior primary care provider delivering value-based care, they play a critical role in achieving Humana's strategic objectives and are poised to meaningfully increase the size of the business by nearly doubling their footprint through growth and expansion efforts over the next two years.The Associate VP, Risk Adjustment ensures that physicians are supported in ensuring that coding is accurate, reflective of disease prevalence in the population, and properly supported by clinical documentation within the health record across the Primary Care Organization. Through hub and spoke model, Responsible for developing, achieving consensus and executing optimal strategy and workflows across the PCO. Up to date on all state, federal and internal policies and procedures and ensure the team is following both the letter of those regulations while analyzing coding information and medical records. Responsible for both onshore and offshore coding teams. Responsible for driving ongoing efficiency and effectiveness of the team through use of people, new process, and technology enablement. May participate in provider education programs on coding compliance. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy.Required Qualifications

  • Master's Degree
  • 10 or more years of technical experience
  • 8 or more years of management experience
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences and business outcomes
  • Strong collaborator able to build rapport and partner with diverse range of leadership styles
  • Proficiency in analyzing and interpreting healthcare data and trends
  • Strong attention to detail and focus on process and quality
  • Excellent communication skills
  • Ability to operate under tight deadlines
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPointPreferred Qualifications
    • Strong vision for how technology enablement can better support this work over time
    • Experience working with product and technology teams to build next generation tools
    • Flexible and embraces changeAdditional InformationAssociates are required to be fully COVID vaccinated, including booster, or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home.If progressed to offer, candidates will be required to:
      • Provide proof of full vaccination, including boosterOR
      • Provide proof of applicable exemption including any required supporting documentationMedical,religious, and state exemptions will be available.#LI-MR1Scheduled Weekly Hours40Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options

Keywords: Centerwell, Torrance , Associate VP, Risk Adjustment, Executive , Torrance, California

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