The Manager, Medical Coding in Payment Integrity leads a team that reviews clinical information from a variety of medical records and advises if appropriate procedural terminology and medical codes (e.g., ICD-10-CM, ICD-10-PCS, DRG, APR-DRG) were billed. The Manager, Medical Coding 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, Medical Coding in payment integrity leads a team that confirms appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information.
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
Required Qualifications
A minimum of an Associate's Degree
5 or more years of experience in medical auditing & coding with a focus on MS-DRG & APR-DRG
2 or more years of management experience in a highly matrixed operational setting
RHIA, RHIT and/or CCS Certification
Experience with data analysis tools such as Power BI
Able to determine the needed approach, resources, and goals to solve problems
Demonstrated experience with cross departmental collaboration
Experienced leading meetings and presenting material to broad audiences
Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
Ability to handle multiple priorities
Capacity to maintain confidentiality
Excellent communication skills both written and verbal
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
6 or more years of work experience related to claims with an understanding claims lifecycles/healthcare revenue cycle management
Experience leading projects and/or processes
Experience in Financial Recovery
Experience with the following systems: CAS, MTV, CISpro and CIS
Current or recent experience in provider relations and/or provider engagement
Experience in a fast paced, metric driven operational setting
Prior experience working with offshore vendors and/or leading a team of offshore associates
Additional Information
Work Style: Remote
HireVue Statement: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Work at Home/Remote Requirements
To ensure Hybrid Office/Home associates’ ability to work effectively, the self-provided internet service of Hybrid Office/Home associates must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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.About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.