Provider Data Validation Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Guide, mentor, and nurture a high-achieving team of 13 associates.

• Propel operational excellence through the optimization of workflows, effective inventory management, and strategic resource planning.

• Track performance metrics, identify potential risks, and apply data-driven strategies for improvement.

• Ensure fair workload distribution while upholding productivity, quality standards, and associate engagement.

• Cultivate a culture of accountability, collaboration, flexibility, and ongoing enhancement.

• Supervise educational initiatives for providers aimed at enhancing coding accuracy, documentation integrity, and provider engagement.

• Guarantee that educational documentation meets the necessary quality, compliance, and audit-readiness standards.

• Maintain documentation accuracy at 95% or higher.

• Implement and finalize annual coding and provider education programs.

• Streamline Record Insights workflows and operational processes.

• Collaborate with various departments to bolster risk adjustment strategies and drive operational transformation.

• Achieve tangible improvements through data analytics, process optimization, and AI-driven innovations.

⛳️ Requirements

• CRC, CPC, CCS, or an equivalent medical coding certification is required.

• A minimum of 2 years of leadership experience within healthcare operations, risk adjustment, coding, provider education, compliance, or a related field.

• Bachelor's degree or a comparable combination of education and experience.

• Proficient in Excel, Power BI, and data analytics tools.

• Preferred experience in Risk Adjustment, Provider Data Validation, Medical Coding, Provider Education, or Healthcare Compliance.

• Familiarity with CMS risk adjustment programs, audit methodologies, and regulatory requirements is preferred.

• Experience utilizing automation, analytics, or AI technologies to enhance operational performance is preferred.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload is required.

• A dedicated workspace free from interruptions to safeguard member PHI/HIPAA information is necessary.

🏝️ Benefits

• Bonus incentive plan available.

• Comprehensive medical benefits.

• Dental benefits provided.

• Vision benefits included.

• 401(k) retirement savings plan.

• Paid time off offered.

• Recognized company holidays.

• Personal holidays available.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance included.

• Support for personal wellness and smart healthcare decision-making.

• Occasional travel to Humana offices for training or meetings may be required.