Provider Data Validation Manager

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead, coach, and develop a high-performing team of 13 associates • Drive operational excellence through workflow optimization, inventory management, and resource planning • Monitor performance metrics, identify risks, and implement data-driven improvement strategies • Ensure equitable workload distribution while maintaining productivity, quality, and associate engagement • Foster accountability, collaboration, adaptability, and continuous improvement • Oversee provider education initiatives to improve coding accuracy, documentation integrity, and provider engagement • Ensure education documentation meets quality, compliance, and audit-readiness standards • Maintain documentation accuracy of 95% or greater • Execute and complete annual coding and provider education initiatives • Optimize Record Insights workflows and operational processes • Partner across the organization to support risk adjustment strategy and operational transformation • Drive measurable improvements through data analytics, process optimization, and AI-enabled innovation

🎯 Requirements

• CRC, CPC, CCS, or equivalent medical coding certification • 2+ years of leadership experience in healthcare operations, risk adjustment, coding, provider education, compliance, or a related field • Bachelor's degree or equivalent combination of education and experience • Proficiency with Excel, Power BI, and data analytics tools • Experience in Risk Adjustment, Provider Data Validation, Medical Coding, Provider Education, or Healthcare Compliance preferred • Knowledge of CMS risk adjustment programs, audit methodologies, and regulatory requirements preferred • Experience leveraging automation, analytics, or AI technologies to improve operational performance preferred • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated work space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness and smart healthcare decision support • Occasional travel to Humana offices for training or meetings