About Humana


Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

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Manager, Medicare Risk Adjustment

Humana - Work At Home, Virginia

Posted: 09/23/2018


The Manager, Medicare Risk Adjustment 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 Manager, Medicare Risk Adjustment 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, Medicare Risk Adjustment ensures coding is accurate and properly supported by clinical documentation within the health record. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. May participate in provider education programs on coding compliance. 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.


Required Qualifications

  • Bachelor's Degree or equivalent
  • 6+ years of technical experience
  • 2+ years of management experience
  • CPC (Certified Professional Coder) Certification required
  • Strong knowledge of ICD-9/10 diagnosis codes
  • Previous experience working in a managed care field
  • Prior supervisory experience
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint

Preferred Qualifications

  • Graduate degree
  • Progressive business consulting and/or operational leadership experience
  • Proficiency in analyzing and interpreting data trends
  • Comprehensive knowledge of Medicare policies, processes and procedures

Additional Information

Scheduled Weekly Hours


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