Become a part of our caring community and help us put health first

The Associate Director - Medicare Risk Adjustment will be responsible for the oversight of Humana's various Risk Adjustment Programs and ensure ongoing compliance with all applicable state and federal guidelines. The Associate Director will set the overall compliance strategy as it relates to Risk Adjustment and help develop and execute, with the help of a team of individuals, the annual auditing and monitoring workplan.

The Associate Director, Medicare Risk Adjustment, plays a crucial role in enhancing our overall compliance processes and will be instrumental in ensuring that our organization adheres to all applicable federal and state regulations concerning Medicare risk adjustment programs.

Responsibilities

• Leadership & Strategy: Provide guidance and leadership to the Medicare Risk Adjustment compliance team. Develop and implement strategic compliance plans to ensure adherence to all regulatory requirements.
• Compliance Oversight: Oversee the management and execution of Risk Adjustment Data Validation (RADV) audits, ensuring compliance with CMS guidelines.
• Policy Development: Develop and maintain comprehensive policies and procedures related to Medicare risk adjustment activities.
• Training & Development: Design and conduct training programs for internal teams to enhance understanding of compliance requirements and practices related to Medicare risk adjustment.
• Risk Assessment: Conduct regular risk assessments to identify potential areas of compliance vulnerability and risk; develop/implement corrective action plans for resolution of problematic issues.
• Stakeholder Engagement: Collaborate with internal departments, including the Law Department, to coordinate compliance activities and resolve issues.
• Reporting: Prepare and present clear and concise compliance reports to senior management.

Use your skills to make an impact

Required Qualifications

• Minimum of 5 years of experience in healthcare
• In-depth knowledge of CMS regulations and guidelines pertaining to Medicare Risk Adjustment
• Demonstrated ability to oversee and enhance compliance programs
• Experience navigating complex legal landscapes and developing and implementing compliance strategies
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with stakeholders at all levels
• Demonstrated ability to manage multiple or competing priorities
• Excellent analytical, organizational, and communication skills
• Bachelor’s degree in business, engineering, data science, or a related field

Preferred Qualifications

• Graduate or advanced degree (MBA or JD)
• Experience with encounter submissions
• Auditing experience

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$123,800 - $170,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.