Senior Risk Adjustment Operation Professional

Profile

Description

The Senior Risk Adjustment or Market Development Professional provides support relative to Medicaid risk adjustment product implementation, operations, contract compliance, and federal contract application submissions. The Senior Market Development Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Market Development Professional serves as the primary resource on Medicaid risk adjustment for all Humana Healthy Horizon plans. Ensures that markets are meeting or exceeding corporate Medicaid risk adjustment requirements. Maintains relationships with chief financial officers and actuaries within a region. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

The Senior Market Development Professional will serve as a Medicaid Risk Adjustment subject matter expert in both CDPS and Johns Hopkins ACG risk models. Responsible for implementation/upkeep of all risk adjustment operations (monthly, quarterly, annual updates), coordination with internal data teams, liaison for individual market CFO's, encounters, and actuary teams. Provide education regarding Medicaid Risk adjustment processes. Responsible for upkeep of documentation for all data processes for risk adjustment by state as well as new state implementations.

Required Qualifications


2 or more years of knowledge and experience with risk adjustment, preferably in CDPS/ACG risk models.
5 or more years of experience in a fast paced insurance or health care setting
Excellent communication skills, both oral and written
Experience implementing and measuring success on complex health-related initiatives and pilots
Strategic thinker with ability to work independently
Strong relationship building skills
Strong analytical skills
Process-focused, with ability to leverage and enhance existing processes
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Healthcare experience
PMP certification
Six Sigma
Proficient with Microsoft Access, Visio and Project


Additional Information

Scheduled Weekly Hours

40

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Company info

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