Manager, Coding Quality
WellSkyFull Time
Senior (5 to 8 years), Expert & Leadership (9+ years)
Candidates must possess a medical coding certification from AAPC or AHIMA, with a minimum of 7 years of experience in medical coding, audit, and CMS and coding compliance. A Bachelor's degree or over 5 years of leadership experience is required, along with at least 1 year of experience in Payment Integrity or vendor management. Strong analytical and decision-making skills, excellent communication and presentation abilities, and experience leading virtual teams with remote training are also necessary.
The Quality Assurance Manager will develop and implement programs to establish and maintain quality standards for products and services, focusing on the quality of care provided to patients. This role involves collaborating with internal departments and vendor partners to support coding programs, ensuring consistent, compliant, and high-quality medical coding practices through education and process improvement. Key responsibilities include refining policies and methodologies for coding accuracy, leading QA initiatives, designing process improvement strategies, providing training, maintaining communication with stakeholders, making strategic decisions on resource allocation, facilitating cross-functional collaboration, and overseeing virtual team engagement.
Health insurance provider for seniors and military
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.