United States onlyBecome a part of our caring community and help us put health first
The Program Management Lead, Offshore Coding Operations conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Program Management Lead, Offshore Coding Operations works on problems of diverse scope and complexity ranging from moderate to substantial.The Program Management Lead, Offshore Coding Operations optimizes the effectiveness of the offshore coding (post-visit) team. The lead analyzes the performance of the offshore coding team and creates strategies to maximize associate output. The Program Management Lead, Offshore Coding Operations works on problems of diverse scope and complexity ranging from moderate to substantial.
Relationship Building:
Cultivate relationships with onshore and offshore coding teams including leaders.
Serve as liaison and primary point of contact with the offshore (vendor) leaders.
Strategy:
Advises coding leaders to develop functional strategies (often segment specific) on matters of significance.
In partnership with Operational Excellence and Divisional Coding Leaders, develop strategies for continuous improvement of offshore coding processes and quality.
Post-Visit/Offshore Coding Collaboration:
Partner with analytics to develop quality assurance program on post-visit reviews. (Frequency and sampling methodology to be determined).
Qualitative and Quantitative Analyses:
Analyze trends and share results with coding leaders/teams.
Monitor quality and address performance gaps.
Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.
May participate in coder education programs on coding compliance.
Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.
Mergers and Acquisitions:
Partner with coding teams (consultative coders) on the special handling of Mergers & Acquisitions:
Other Duties:
Lead Special Projects for onshore and offshore coding teams.
Participate in hart reviews to identify educational opportunities.
Conduct research as needed.
Participate in Payer calls/chart reviews.
May participate in provider education programs on coding compliance.
Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.
Use your skills to make an impact
Proposed Requirements:
- Bachelor’s degree in a relevant field (e.g., Health Information Management, Business Administration, Healthcare Administration)
- Active professional certification required: RHIA, RHIT, CCS, CRC, or CPC
- Minimum 5 years’ progressive experience in medical coding operations
- Minimum of 3 years’ direct experience managing or optimizing offshore coding teams and vendor partnerships
- Demonstrated success leading cross-functional initiatives and continuous improvement efforts in large, matrixed healthcare organizations
- Experience collaborating with analytics, training, and operational excellence teams to drive quality and efficiency in coding workflows
- Prior exposure to supporting mergers & acquisitions in a coding operations context preferred
Preferred Qualifications
- Master’s degree preferred.
Knowledge, Skills, and Abilities
- Advanced understanding of medical coding guidelines, healthcare regulations (including HIPAA, state and federal compliance), and payer requirements
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and relevant coding/audit software
- Strong business acumen with proven strategic and critical thinking skills
- Ability to analyze complex quantitative and qualitative data, synthesize findings, and communicate actionable insights to leadership
- Outstanding verbal and written communication skills, with the ability to present to and influence diverse stakeholder groups
- Effective relationship-building skills with both onshore and offshore teams, including vendor management and leadership liaison
- Proven ability to work successfully in a fast-paced, dynamic, and matrixed environment
- Commitment to continuous improvement, operational excellence, and collaborative problem-solving
- Public speaking and group presentation experience required
- Demonstrated ability to educate and mentor staff on coding compliance and best practices
Additional Information
- Preferred work hours: EST
- Up to 20% travel nationally within CenterWell markets
Work at Home Requirements
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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
Employees 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 employees with telephone 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.$104,000 - $143,000 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.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.Application Deadline: 11-14-2025
About us
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
