About Humana


Job Category:

Member Quality & Financials - Risk Adjustment & STARS operations


United States

Postal Code:


Approximate Salary:

Not Specified

Position Type:

Full time

This job has expired and you can't apply for it anymore. Start a new search.

Manager, Risk Adjustment

Humana - Anderson, South Carolina

Posted: 07/4/2018


The Manager, 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, 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, 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

  • Five+ years certified medical coder
  • Resident of South Carolina
  • Two+ years of progressive leadership in healthcare administration and operations.
  • Proven interpersonal skills with the ability to interface effectively both internally  and externally  with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA’s, community organizations and other health plan staff.
  • Knowledge of and experience working with Provider Communities.
  • Knowledge of Excel, Word and Power Point Presentations in a business setting
  • A high level of engagement and emotional intelligence.
  • Direct leadership experience, demonstrating capability in leading cross functional teams.
  • Excellent verbal, written communications skills

Preferred Qualifications

  • RN or LPN
  • Bachelor’s Degree preferably in Business Administration, Healthcare Administration or related field.
  • Experience with Value based coding methodology
  • Proven ability to function effectively in matrix management environment and as a member of an interdisciplinary team
  • Experience with Electronic Medical Records/EMR and/or Health Information Management/HIM systems
  • Solid understanding of medical care delivery, managed care financial arrangements and reimbursement
  • Experience in health plan, health care management, managed care operations, and/or provider practice within a multi-physician medical center, clinical group, or hospital setting.
  • Knowledge of Population Health Strategy, and Quality based patient care programs.
  • HCC or Risk Coding preferred

Additional Information

Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. 

Scheduled Weekly Hours


Apply Now
This job has expired and you can't apply for it anymore