Humana Inc. is looking for a Manager, Risk Adjustment to ensure the accuracy and compliance of medical coding submitted to regulatory agencies. In this leadership role, you'll apply your expertise in ICD-10 codes and managed care operations to protect Humana's commitment to putting health first.
What You'll Do
- Conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies.
- Supervise and provide day-to-day oversight to a group of support and technical associates.
- Ensure coding is accurate and properly supported by clinical documentation within the health record.
- Follow state and federal regulations and internal policies while analyzing coding information and medical records.
- May participate in provider education programs on coding compliance.
- Coordinate cross-departmental collaboration and conduct briefings and area meetings.
What We're Looking For
- 4 or more years of technical experience.
- Strong knowledge of ICD-9/10 diagnosis codes.
- Previous experience working in a managed care field.
- Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint.
- Ability to travel up to 20% of the time within region.
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Nice to Have
- Bachelor's Degree.
- CPC (Certified Professional Coder) Certification.
- 2 or more years of management/supervisory experience.
- Progressive business consulting and/or operational leadership experience.
- Proficiency in analyzing and interpreting data trends.
- Comprehensive knowledge of Medicare policies, processes and procedures.
Technical Stack
- Microsoft Office (Word, Excel, PowerPoint)
Team & Environment
Supervises a group of typically support and technical associates. Coordinates and provides day-to-day oversight to associates.
Benefits & Compensation
- Compensation: $86,300 - $118,700 per year.
- Medical, dental and vision benefits.
- 401(k) retirement savings plan.
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave).
- Short-term and long-term disability.
- Life insurance.
Work Mode
This is a hybrid position.
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 protected veteran status.
