AVP, Medicaid Risk Adjustment

Overview

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The Associate Vice President, Medicaid Risk Adjustment leads the strategic direction, execution, and oversight of all Medicaid risk adjustment programs and initiatives. This role is responsible for ensuring the organization's Medicaid risk adjustment operations are compliant, efficient, and optimized for business performance and member health outcomes. The AVP will collaborate cross-functionally with actuarial, clinical, compliance, and operational teams, and will represent the Medicaid risk adjustment function to executive leadership and external partners.

• Provide strategic and operational leadership for all Medicaid risk adjustment activities, including the development and implementation of risk adjustment models, processes, and analytics.

• Oversee the design, monitoring, and continuous improvement of risk assessment, data submission, and documentation practices to ensure accuracy, compliance, and completeness.

• Lead a multidisciplinary team responsible for the end-to-end Medicaid risk adjustment process

• Ensure compliance with federal and state Medicaid regulations, guidelines, and reporting requirements related to risk adjustment.

• Partner with actuarial and finance teams to analyze Medicaid risk adjustment revenue and financial impacts.

• Collaborate with clinical and provider engagement teams to enhance provider education, documentation practices, and overall quality of risk adjustment data.

• Develop and maintain relationships with state agencies, regulators, and external partners to ensure alignment and advocacy for the organization's Medicaid risk adjustment interests.

• Monitor industry trends, regulatory changes, and best practices to inform strategy and maintain a competitive edge.

• Prepare and deliver reports, presentations, and recommendations to executive leadership and key stakeholders.

• Lead a team of ~20 associates with 4 direct reports and foster a culture of compliance, accountability, and continuous improvement within the Medicaid risk adjustment team.

• Bachelor s degree in actuarial science, mathematics, healthcare administration, business, or related field; advanced degree or actuarial credentials preferred.

• Minimum 8 years of progressive experience in risk adjustment, healthcare finance, or Medicaid managed care, with at least 3 years in a leadership capacity.

• Deep knowledge of Medicare and/or Medicaid risk adjustment models, methodologies, and federal/state regulatory requirements. Medicaid preferred.

• Experience leading multidisciplinary teams and large-scale projects in a matrixed environment.

• Strong analytical, financial modeling, and project management skills.

• Excellent written and verbal communication abilities, with experience presenting to executive audiences.

• Demonstrated ability to build collaborative relationships with internal and external partners.

• Commitment to integrity, compliance, and quality improvement.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$203,400 - $279,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid…