IPA Consultative Coding Manager

Overview

Become a part of our caring community. The Manager, IPA Consultative Medical Coding leads a team of consultative coders supporting value-based care delivery across a defined geographic region. You will oversee regional coding operations to ensure agreement on provider engagement, risk adjustment accuracy, and documentation excellence. You will guide the transition from a retrospective coding model to a model that strengthens clinical documentation and coding performance.

Your success requires strong leadership and technical expertise to address complex operational challenges, accomplish regional strategy, and deliver results aligned with organizational goals.

• Provide leadership and operational oversight for a team of IPA Consultative Coders within an assigned region
• Accountable for regional coding performance, provider engagement, and risk adjustment outcomes
• Align coding operations with market-specific provider needs, growth strategies, and membership trends
• Partner with Provider Engagement leadership to ensure coordinated support and a consistent provider experience
• Collaborate with STARS leaders and champions to identify STARS gaps and deficiencies

• Lead implementation of the Consultative Coding Model, transitioning from retrospective workflows to longitudinal provider support
• Ensure delivery of quarterly provider chart reviews, real‑time coding support through a daily helpdesk, provider education on coding accuracy and documentation standards, and real‑time analysis of trends, triage, and answers
• Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues
• Increase adoption and optimization of coding tools, including APD 2.0, Stellar, Healow, and MRA 4.0 (POCA)

• Lead, coach, and develop a high‑performing team of consultative coders
• Establish expectations for provider engagement, coding quality, and productivity
• Support hiring, onboarding, and workforce planning with care for regional demand
• Promote a culture of accountability, learning, and clinical excellence

• Ensure compliance with ICD‑10‑CM, HCC guidelines, and CMS risk adjustment methodologies
• Oversee quality outcomes from chart reviews and coding audits
• Identify documentation gaps and implement targeted education programs
• Partner with Coding Excellence and Compliance to maintain regulatory adherence

• Translate organizational goals into regional plans, goals, and performance metrics
• Monitor and report on indicators including coding accuracy, recapture rates, provider engagement, and efficiency
  
  Address workflow inefficiencies, coverage gaps, and provider needs through targeted problem‑solving
• Support programs across analytics, technology, and operations

Join us to influence the quality of patient care and help shape a healthier future for our members.

• Bachelor’s Degree or 5+ years of relevant risk adjustment coding experience within a healthcare setting
• 3+ years of leadership or management experience
• Certified Professional Coder (CPC) or equivalent certification (RHIA, RHIT, CRC, or CCS)

• Expertise in risk adjustment, HCC coding, and CMS guidelines
• Experience in provider‑facing coding education, documentation improvement, or clinical engagement; passionate about improving consumer experiences
• Experience supporting value‑based care models or IPA/MSO environments
• Experience leading field‑based or hybrid teams

• In‑center presence required; daily commute to assigned clinic(s) and occasional quarterly travel within the market
• Workstyle:
  Hybrid/remote
• Location:
  
  Must reside within the states of Texas or Nevada
• Hours:
  
  Monday–Friday, 8:00 AM–5:00 PM; additional time may be required

• TB Statement:
  This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program; TB screening required if selected
• Driving Statement:
  Role requires a valid state driver’s license and personal vehicle liability insurance as specified
• Wo…