Associate Director, Risk Adjustment Audit
Welcome to Humana, a leading healthcare company dedicated to helping our members achieve their best health. We are currently seeking a highly qualified and driven individual to join our team as the Associate Director, Risk Adjustment Audit. In this role, you will play a crucial role in ensuring the accuracy and completeness of our risk adjustment processes, helping us to effectively manage costs and provide quality care to our members. If you have a strong background in risk adjustment and a passion for making a positive impact in the healthcare industry, we encourage you to apply for this exciting opportunity.
- Oversee and manage all aspects of risk adjustment audits within the organization.
- Develop and implement risk adjustment audit policies and procedures to ensure compliance with industry regulations and standards.
- Collaborate with cross-functional teams to identify and address any gaps or opportunities for improvement in risk adjustment processes.
- Conduct regular audits to verify the accuracy and completeness of risk adjustment data, and provide recommendations for corrective action if necessary.
- Analyze audit results and communicate findings to senior management, providing insights and recommendations for risk adjustment strategies.
- Stay updated on industry trends and changes in risk adjustment methodologies and regulations, and ensure compliance within the organization.
- Work closely with internal and external stakeholders, including providers, to educate and train on risk adjustment best practices.
- Monitor and report on key metrics related to risk adjustment, such as HCC coding accuracy and completeness.
- Collaborate with IT teams to ensure effective implementation and utilization of risk adjustment tools and systems.
- Provide leadership and guidance to a team of risk adjustment auditors, ensuring their professional development and success.
Extensive Knowledge Of Risk Adjustment Strategies: The Ideal Candidate Should Have A Deep Understanding Of The Risk Adjustment Process, Including Coding And Documentation Requirements, To Effectively Manage And Oversee Audits. This Includes Experience With Cms-Hcc And Hhs-Hcc Models, As Well As Other Risk Adjustment Methodologies.
Strong Analytical Skills: As An Associate Director, Risk Adjustment Audit, The Individual Will Be Responsible For Analyzing Large Datasets And Identifying Trends And Patterns To Assess The Accuracy And Completeness Of Risk Adjustment Submissions. Therefore, Strong Analytical Skills, Including Proficiency In Data Mining And Statistical Analysis, Are Key Qualifications For This Role.
Leadership Experience: The Candidate Should Have Previous Experience In A Leadership Role, Preferably In A Risk Adjustment Or Audit Setting. This Includes Managing A Team, Setting Goals And Objectives, And Driving Performance To Meet Organizational Goals. Experience In Developing And Implementing Risk Adjustment Training Programs Is Also Desirable.
Excellent Communication Skills: This Position Requires Frequent Communication With Various Stakeholders, Including Providers, Health Plan Leadership, And Regulatory Agencies. Therefore, Excellent Written And Verbal Communication Skills Are Essential For Effectively Conveying Complex Information And Providing Guidance And Feedback To Team Members.
Compliance And Regulatory Knowledge: The Ideal Candidate Should Possess A Strong Understanding Of Compliance And Regulatory Requirements In The Healthcare Industry, Particularly Related To Risk Adjustment. This Includes Knowledge Of Cms Guidelines And Regulations, As Well As Familiarity With Industry Best Practices And Emerging Trends. Experience With Cms Audits And Responding To Audit Findings Is Also A Valuable Qualification.
Quality Assurance
Process Improvement
Communication Skills
Project Management
Data Analysis
Auditing
Compliance
Team Leadership
Risk assessment
Policy Development
Coding Knowledge
Medicare Advantage
Communication
Conflict Resolution
Leadership
Time management
Interpersonal Skills
creativity
Attention to detail
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Associate Director, Risk Adjustment Audit is $89,000 to $130,000 per year. However, this can vary depending on factors such as location, industry, and years of experience. Some companies may also offer bonuses and benefits in addition to base salary.
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Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.
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