Lead, Organic Risk Adjustment

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $115.2k - $158.4k / year

⏰ Full Time

🟠 Senior

🎲 Risk

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Build and operationalize programs that improve organic risk adjustment performance • Develop workflows, playbooks, provider engagement approaches, and reporting processes from the ground up • Identify opportunities, create action plans, and personally drive implementation through completion • Manage multiple initiatives simultaneously, ensuring deliverables are completed on time and produce measurable results • Serve as the point person for day-to-day execution of Organic Risk Adjustment initiatives • Partner directly with providers, practice leaders, operations teams, and clinical stakeholders to improve documentation and coding performance • Create practical solutions that fit within existing clinical workflows • Lead meetings, track action items, and ensure accountability across stakeholders • Analyze data to identify documentation and risk capture opportunities • Translate insights into operational actions and measurable performance improvement • Monitor outcomes and adjust programs based on results.

🎯 Requirements

• Bachelor’s degree or equivalent experience • 6+ years of related lead level experience • Experience in Medicare Advantage risk adjustment, RAF performance, clinical documentation improvement, coding, quality, or value-based care operations • Demonstrated ability to lead cross-functional initiatives involving clinical, coding, analytics, quality, and operational stakeholders • Experience developing provider education, documentation improvement strategies, and performance feedback processes • Ability to analyze data trends, identify root causes, and translate insights into operational action plans • Strong communication, facilitation, and stakeholder management skills • Ability to manage multiple priorities in a fast-paced, highly regulated healthcare environment.

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance and many other opportunities