VP HQRI Operations - Humana
Louisville, KY
About the Job
Become a part of our caring community and help us put health first
Humana is a $100 billion (Fortune 42) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.
Against that backdrop, we are seeking a talented executive for the position of Vice President (VP), HQRI Operations. This position plays a crucial role leading and driving strategic initiatives to optimize risk adjustment operations and solutions that deliver quality outcomes and business value. This role impacts our overall Medicare and Medicaid strategy, as it impacts the revenue needed to fund benefits.
The VP, HQRI Operations will create and own the strategic plan for enterprise risk adjustment operations. This position will report directly to the SVP, Risk Adjustment and Interoperability and lead a multi-level organization of more than 500 associates, with approximately 5 direct reports. This position will have coordination and oversight of multiple vendors including medical record retrieval and coding vendors, as well as all internal operational partners. This position will have oversight and support of all Medicare Market MRA functions.
The VP, HQRI Operations can be located anywhere within the contiguous United States, although a major city in the Eastern U.S. would be ideal. Moderate travel (~20%) should be expected.
Key Responsibilities
+ Responsible for all Operations within Risk Adjustment, including but not limited to
+ Medical Record Retrieval for all Medicare and Commercial Risk Adjustment functions (retrospective review and all compliance and audit processes) and HEDIS
+ Coding Operations for Medicare and Commercial Risk Adjustment
+ Management of multiple vendors who provide workflow, retrieval and coding operations, imaging vendors and provider outbound call center vendor
+ Encounter submissions on EDS while creating efficiencies through technology functions for Medicare, Commercial and Medicaid and implementation of any new states for Medicaid
+ Dual Eligible Outreach team - outbound member call center responsible for Medicaid activations
+ Oversight and support of all market MRA functions, and being the centralized function to coordinate all activities, including re-rentry, productivity, and serve as single coordination point for market Risk Adjustment Operations (serves as functional resource for Segment Presidents to ensure consistency)
+ Training and education for all risk adjustment functions
+ Policies and procedures for all risk adjustment functions
Use your skills to make an impact
Key Candidate Qualifications
The ideal candidate will have extensive leadership experience (typically 10+ years) in the healthcare industry, specifically in risk adjustment operations. He/she will have expertise in the development and execution of operational strategies along with a record of success working in a highly matrixed environment. Finally, this person will be a strong leader of people with proven success in expanding and elevating the capabilities and performance of a multi-level team and large-scale organization.
In addition, the following professional credentials and personal attributes are also sought:
+ Bachelor's degree in healthcare administration, business, or a related field. Master's degree is highly desired.
+ In-depth understanding of partners/functions within and outside the segment. Understanding of how organization capabilities interrelate across segments and enterprise-wide.
+ Demonstrated ability in building strategic relationships with internal and external parties, including cross-functional partners, corporate and market functions, vendors and providers.
+ Deep knowledge of the health insurance industry, competitive landscape, Medicare operations end-to-end and a keen respect for compliance and legal guidelines.
+ Proven ability to manage the complexity of competing priorities.
+ Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences, both internally and externally.
+ Current or recent experience in a large, highly matrixed company (i.e., Fortune 150), with proven ability to influence leaders and key stakeholders and achieve successful outcomes in such an environment.
+ Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome
Scheduled Weekly Hours
40
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Humana is a $100 billion (Fortune 42) market leader in integrated healthcare with a clearly defined purpose to help people achieve lifelong well-being. As a company focused on the health and well-being of the people we serve, Humana is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.
Against that backdrop, we are seeking a talented executive for the position of Vice President (VP), HQRI Operations. This position plays a crucial role leading and driving strategic initiatives to optimize risk adjustment operations and solutions that deliver quality outcomes and business value. This role impacts our overall Medicare and Medicaid strategy, as it impacts the revenue needed to fund benefits.
The VP, HQRI Operations will create and own the strategic plan for enterprise risk adjustment operations. This position will report directly to the SVP, Risk Adjustment and Interoperability and lead a multi-level organization of more than 500 associates, with approximately 5 direct reports. This position will have coordination and oversight of multiple vendors including medical record retrieval and coding vendors, as well as all internal operational partners. This position will have oversight and support of all Medicare Market MRA functions.
The VP, HQRI Operations can be located anywhere within the contiguous United States, although a major city in the Eastern U.S. would be ideal. Moderate travel (~20%) should be expected.
Key Responsibilities
+ Responsible for all Operations within Risk Adjustment, including but not limited to
+ Medical Record Retrieval for all Medicare and Commercial Risk Adjustment functions (retrospective review and all compliance and audit processes) and HEDIS
+ Coding Operations for Medicare and Commercial Risk Adjustment
+ Management of multiple vendors who provide workflow, retrieval and coding operations, imaging vendors and provider outbound call center vendor
+ Encounter submissions on EDS while creating efficiencies through technology functions for Medicare, Commercial and Medicaid and implementation of any new states for Medicaid
+ Dual Eligible Outreach team - outbound member call center responsible for Medicaid activations
+ Oversight and support of all market MRA functions, and being the centralized function to coordinate all activities, including re-rentry, productivity, and serve as single coordination point for market Risk Adjustment Operations (serves as functional resource for Segment Presidents to ensure consistency)
+ Training and education for all risk adjustment functions
+ Policies and procedures for all risk adjustment functions
Use your skills to make an impact
Key Candidate Qualifications
The ideal candidate will have extensive leadership experience (typically 10+ years) in the healthcare industry, specifically in risk adjustment operations. He/she will have expertise in the development and execution of operational strategies along with a record of success working in a highly matrixed environment. Finally, this person will be a strong leader of people with proven success in expanding and elevating the capabilities and performance of a multi-level team and large-scale organization.
In addition, the following professional credentials and personal attributes are also sought:
+ Bachelor's degree in healthcare administration, business, or a related field. Master's degree is highly desired.
+ In-depth understanding of partners/functions within and outside the segment. Understanding of how organization capabilities interrelate across segments and enterprise-wide.
+ Demonstrated ability in building strategic relationships with internal and external parties, including cross-functional partners, corporate and market functions, vendors and providers.
+ Deep knowledge of the health insurance industry, competitive landscape, Medicare operations end-to-end and a keen respect for compliance and legal guidelines.
+ Proven ability to manage the complexity of competing priorities.
+ Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with senior and executive level audiences, both internally and externally.
+ Current or recent experience in a large, highly matrixed company (i.e., Fortune 150), with proven ability to influence leaders and key stakeholders and achieve successful outcomes in such an environment.
+ Highly collaborative mindset and excellent relationship-building skills, including the ability to engage many diverse stakeholders and SMEs and win their co-ownership in the outcome
Scheduled Weekly Hours
40
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana