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

The Senior Risk Adjustment Administration Professional will work closely with providers to identify documentation and coding improvement opportunities and give guidance around operational and clinical best practices in the risk adjustment methodology.

This role reports to the Risk Adjustment Manager and will work closely with market operations, finance and clinical team to effectively influence a provider to adopt best practices in the risk adjustment methodology.

The successful candidate will possess extensive, in-depth and broad knowledge of the HCC risk adjustment methodology gained from actual experience of chronic condition documentation and coding audits, risk adjustment program implementation and provider education delivery. An ideal candidate will also have the ability to look at provider performance metrics and be able identify where the risk adjustment gaps exist and how to close them with available resources by putting together an action plan. This also requires a commitment to cultivating internal and external business relationships to achieve desired outcomes.

• Develop a comprehensive understanding of Humana’s risk adjustment programs and the resources required for successful implementation.

• Develop and apply keen insight of our providers and our KPIs, and be able to strategically assess where improvements can be made in the most effective way with available resources.

• Perform analysis of performance indicators and put together a formal presentation for reporting out to providers on a regularly scheduled basis.

• Provide measurable, actionable solutions to providers that will result in improved accuracy of documentation and coding, and adoption of best practices.

• Successfully implement identified course of action to effectively impact risk adjustment deadlines and report on progress regularly.

• Assist providers in understanding the CMS - HCC Risk Adjustment program as a payment methodology and the importance of proper chart documentation.

• Knowledge of EMR interoperability solutions to influence provider groups in population health management

• Facilitate presentations and train physicians and other staff regarding documentation, billing and ICD10 coding, and provide feedback to physicians regarding documentation practices and compliance with state and federal regulations.

• Cultivate effective partnerships in a matrix environment of coding educators, medical director, clinical and market operations.

• Facilitate, track and trend for reporting to leadership and participating groups and be able to make recommendations for improvement.

Use your skills to make an impact

Required Qualifications

• 5+ years of experience in risk adjustment coding/auditing/education and provider relations/engagement

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)

• Prior experience in successfully engaging with providers to participate in performance improvement programs

• In-depth knowledge of risk adjustment key performance indicators and CMS payment models (V24 and V28)

• Prior experience working in a cross-functional team

• Expert facilitation and presentation skills to include online delivery

• Advanced Microsoft Office skills including Word, Excel, Outlook and PowerPoint

• Advanced knowledge of billing / claims submission and other related functions

• Demonstrated ability to manage competing priorities and to effectively manage projects simultaneously

• Demonstrated ability to adapt quickly to change

• Must work market designated time zone (Mountain or Pacific Time Zone)

Preferred Qualifications

• Bachelor’s Degree

• Certified Risk Adjustment Coder (CRC)

• Certified Documentation Expert Outpatient (CDEO)

• Knowledge of EMR (Athena, Epic and eCW)

• Experience gained in risk adjustment field in physician practice or provider group

Additional Information

• Must work market designated time zone (Mountain or Pacific Time Zone)

Benefits Information:

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1

• Paid time off, holidays, volunteer time and jury duty pay

• Recognition pay

• 401(k) retirement savings plan with employer match

• Tuition assistance

• Scholarships for eligible dependents

• Parental and caregiver leave

• Employee charity matching program

• Network Resource Groups (NRGs)

• Career development opportunities

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work At Home / Internet Guidance:

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

SSN Information:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

$78,400 - $107,800 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.Application Deadline: 04-15-2025

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 veteran status. 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.