Error 2318 ::The remote server returned an error: (404) Not Found. Teacher Job Albuquerque New Mexico | Medicare Risk Adjustment Learning Consultant Humana

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Teacher Job in Albuquerque, New Mexico : NM 87101

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Medicare Risk Adjustment Learning Consultant

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Medicare Risk Adjustment Learning Consultant Job Description

Role: Medicare Risk Adjustment Learning Consultant
Assignment: Senior Medicare Products / MRA

Location: Albuquerque, NM

Assignment Capsule

Humana is seeking a Provider Education Consultant who will take ownership of Medicare Risk Adjustment (MRA) programs that fit best with our providers by identifying operational and clinical best practices in the risk adjustment methodology, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding. This role reports to the MRA Manager and as a member of the MRA team will work closely with market operations, finance and clinical teams to effectively match the right program to providers, put together an action plan, effectively engage providers, implement plans and monitor. The Provider Education Consultant will also coordinate implementation of programs designed to ensure all diagnoses are coded according to CMS and risk adjustment coding guidelines and conditions are properly supported by appropriate documentation in the patient chart. Work will require 30% travel.

Key Role Objectives/Responsibilities

  • 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 risk adjustment improvements can be made in the most effective way with available resources

  • Build a strong collaborative relationship with our providers to set the stage for successful engagement with risk adjustment programs

  • Successfully implement identified course of action to effectively impact risk adjustment deadlines and report on progress regularly; possess the ability to fill gaps between actual situations and desired ones

  • Facilitate and/or perform an audit of the providers medical chart to ensure appropriate documentation exists to support the diagnoses submitted appropriately and also to identify trends in documentation for use in provider education and feedback on a regularly scheduled basis

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

  • Monitor KPIs through analytics and identify providers for Medicare Risk Adjustment training, programs and documentation/coding resources

  • Consult with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic codes; query providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding

  • Provide
  • ICD10 - HCC coding training to providers and appropriate staff

  • Facilitate coding presentations and training to large and small groups of clinicians, practice managers and certified coders developing training to fit specific provider's needs

  • Train physicians and other staff regarding documentation, billing and coding and provide feedback to physicians regarding documentation practices and compliance with state and federal regulations

  • Provide measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices and adopt CMS best practices

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

Albuquerque Teacher Job

Medicare Risk Adjustment Learning Consultant Job Requirements

Role Essentials

  • Certified Professional Coder & CPC-I
  • Experience in HCC risk adjustment in the following areas: provider relations, education and training of providers and medical office staff, and HCC coding from a payer perspective at least
  • Experience in successfully engaging with providers to participate in performance
  • improvement programs
  • Familiarity with key performance metrics in HCC risk adjustment
  • Prior experience working in a cross-functional team
  • Demonstrated ability to manage competing priorities and quickly adapt to change
  • Ability to effectively manage projects simultaneously
  • Strong facilitation, presentation skills and Microsoft office skills
  • Knowledge of EMR


Role Desirables

  • Bachelor Degree


Reporting Relationship

You will report to a MRA Manager. 

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