Humana is looking to solve the problem of ensuring coding accuracy, elevating quality standards, and driving process improvement initiatives within the Payment Integrity organization and Vendor Partners
Requirements
- Medical coding certification (AAPC or AHIMA)
- Minimum 7 years of experience in medical coding, audit, and CMS and coding compliances
- At least 1 year of experience in Payment Integrity or vendor management
- Experience conducting quality audits and identifying performance metrics
- Background in compliance and risk mitigation strategies
- Demonstrated success in process improvement and operational efficiency initiatives
- Experience leading virtual teams and conducting remote training
Responsibilities
- Develops and refines policies, procedures, and methodologies to monitor and improve coding accuracy and operational quality across internal teams and vendor partners
- Leads quality assurance initiatives aimed at identifying coding discrepancies, improving audit outcomes, and ensuring compliance with regulatory and contractual standards
- Designs and implements process improvement strategies to enhance efficiency, reduce errors, and optimize coding workflows across the Payment Integrity ecosystem
- Provides training and coaching to staff and vendor leadership on quality improvement techniques, coding standards, and documentation best practices
- Maintains ongoing communication with medical staff, vendor partners, and internal stakeholders to share QA insights and foster continuous improvement
- Makes strategic decisions regarding resource allocation, project execution, and operational priorities in alignment with Payment Integrity goals
- Facilitates cross-functional collaboration and leads meetings to ensure transparency and alignment across internal and external teams
Other
- Bachelor’s degree or 5+ years of leadership experience
- Strong analytical and decision-making skills
- Excellent communication and presentation skills
- Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
