Manager, Risk Adjustment

Manager, Risk Adjustment

Humana

We are looking for a Manager, Risk Adjustment to conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies. The Manager works within specific guidelines and procedures, applies advanced technical knowledge to solve moderately complex problems, manages assignments in the form of objectives and determines approach, resources, schedules, and goals.

The Manager performs escalated or more complex work, supervises a group of support and technical associates, coordinates day‑to‑day oversight, ensures consistency in execution across the team, and holds team members accountable for following established policies. They ensure coding accuracy and proper clinical documentation, follow state and federal regulations, participate in provider education programs on coding compliance, and collaborate cross‑departmentally for briefings and area meetings.

• 4 or more years of technical experience
• Strong knowledge of ICD-9/10 diagnosis codes
• Previous experience working in a managed care field
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Power Point
• Ability to travel up to 20% of the time within region
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Bachelor's Degree
• CPC (Certified Professional Coder) Certification
• 2 or more years of management/supervisory experience
• Progressive business consulting and/or operational leadership experience
• Proficiency in analyzing and interpreting data trends
• Comprehensive knowledge of Medicare policies, processes and procedures

Work‑at‑home or hybrid home/office employees must have internet service meeting the following criteria: at minimum, download speed of 25 Mbps and upload speed of 10 Mbps (wireless, wired cable or DSL connection suggested). Satellite, cellular and microwave connections may be used only if approved. Employees who live and work from home in California, Illinois, Montana, or South Dakota will receive bi‑weekly payment for internet expense.

Humana will provide telephonic equipment as required. Work will be performed from a dedicated space free of interruptions to protect PHI/HIPAA information.

SSN Alert:
Humana values personal identity protection. Applicants may be asked to provide their Social Security Number. When required, an email will be sent from  with instructions on how to add the information to your official application on Humana’s secure website.

Travel:
While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.

40 hours per week

The compensation range reflects a good faith estimate of starting base pay for full‑time (40 hours per week) employment at the time of posting. Pay range may be higher or lower based on geographic location and individual experience. $86,300 – $118,700 per year.

This job is eligible for a bonus incentive plan based on company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole‑person well‑being. Benefits include medical, dental and vision coverage, a 401(k) retirement savings plan, paid time off, volunteer time off, paid parental and caregiver leave, short‑term and long‑term disability, life insurance and other opportunities.

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and Center Well healthcare services, we make it easier for the millions of people we serve to achieve their best health.

Humana does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Humana takes affirmative action to employ and advance individuals with disability or protected veteran status, and bases all employment decisions on valid job requirements.

Mid‑Senior level

Full‑time

Finance and Sales

Insurance