Quality Assurance Manager
Humana
full-time
Posted on:
Location: California, Illinois, Kentucky, Montana • 🇺🇸 United States
Visit company websiteSalary
💰 $104,000 - $143,000 per year
Job Level
SeniorLead
About the role
- Develops and refines policies, procedures, and methodologies to monitor and improve coding accuracy and operational quality across internal teams and vendor partners
- Plays a pivotal role in ensuring coding accuracy, elevating quality standards, and driving process improvement initiatives within the Payment Integrity organization 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
- Collaborates and supports coding programs within internal department and vendor partners to promote consistent, compliant, high-quality coding 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
- Oversees virtual team engagement, including remote training sessions, vendor performance reviews, and audit feedback loops
Requirements
- Medical coding certification (AAPC or AHIMA)
- Minimum 7 years of experience in medical coding, audit, and CMS and coding compliances
- Bachelor’s degree OR 5+ years of leadership experience
- At least 1 year of experience in Payment Integrity or vendor management
- Strong analytical and decision-making skills
- Excellent communication and presentation skills
- Experience leading virtual teams and conducting remote training
- Experience conducting quality audits and identifying performance metrics (Preferred)
- Background in compliance and risk mitigation strategies (Preferred)
- Demonstrated success in process improvement and operational efficiency initiatives (Preferred)
- Self-provided internet service meeting minimum recommended speeds (download 25 Mbps / upload 10 Mbps)
- Ability to work from a dedicated space protecting PHI / HIPAA
- Occasional travel to Humana offices may be required