Senior Risk Adjustment Administration Professional – Remote Opportunity NV, CA or AZ

The Senior Risk Adjustment Administration professional is responsible for coordinating the implementation of MRA initiatives and work plans for assigned delegated provider groups/IPAs. Acts as the Market Alignment Representative for assigned region(s). Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action and strong project management skills.

Responsibilities

The Senior Risk Adjustment Administration professional is responsible for coordinating the implementation of MRA initiatives and work plans for assigned delegated provider groups/IPAs. Acts as the Market Alignment Representative for assigned region(s). Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action and strong project management skills. Strong analytical and problem-solving skills required for moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Job Responsibilities

• Understands the various risk adjustment levers, drivers, programs and strategies that can be implemented to improve a group’s/IPA’s MRA performance and makes recommendations appropriately.
• Maintains (existing) or designs (new) MRA IPA strategies/work plans for each assigned IPA in market aligned region in collaboration with and some limited direction of MRA Leader/Director.
• Communicates with other operational areas in the organization (e.g. assigned coding educators on MRA team, Provider Engagement, Stars, and Corporate HQRI) as needed to move MRA work plans, initiatives and outcomes forward.
• Monitors progress and performance against the work plans, including implementation targets and milestones; takes action to resolve operational problems and minimize delays with support of MRA Leader/Director.
• Conducts meetings and prepares reports and presentations to communicate the status of the work plans and initiatives, with both internal and external stakeholders.

Required Qualifications

• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Exercises independent judgment; recommendations to management are given considerable weight
• Applies extensive in-depth or broad knowledge in the performance of a variety of difficult assignments; regularly uses new technologies, theories, concepts
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Is proactive.
• Follows established guidelines/procedures, especially with respect to MRA compliance.
• CPC or equivalent certification preferred; risk adjustment background required
• Must possess excellent presentation and written communication skills
• Intermediate to advanced skill in PowerPoint and Excel.
• Newly hired individuals will now be required to submit proof of vaccination or undergo weekly testing, wear face coverings and maintain social distancing protocols when working outside of their home.
• Candidates must reside in CA, NV or AZ to be considered for this position
  

Preferred Qualifications


• Bachelor’s degree (in related medical field) or equivalent work experience.

Additional Information

For this job, associates are required to be fully COVID vaccinated (preferred) 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. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If Progressed To Offer, You Will Be Required To


• Provide proof of full vaccination or commit to testing protocols OR  
• Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state and remote-only work exemptions are available.

Scheduled Weekly Hours

40