Manager, Risk Adjustment

Humana

2d • Remote

About The Position

Become a part of our caring community and help us put health first The Manager, Risk Adjustment conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Manager, Risk Adjustment works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Risk Adjustment performs escalated or more complex work of a similar nature, and supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates. Ensures consistency in execution across team. Holds team members accountable for following established policies. The Manager Risk Adjustment ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. May participate in provider education programs on coding compliance. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department. Use your skills to make an impact

Requirements

• 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 Haves

• 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

Responsibilities

• Conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes
• Supervises a group of typically support and technical associates; coordinates and provides day-to-day oversight to associates
• Ensures consistency in execution across team
• Holds team members accountable for following established policies
• Ensures coding is accurate and properly supported by clinical documentation within the health record
• Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records
• May participate in provider education programs on coding compliance

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 parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees