Become a part of our caring community and help us put health first
 

The Program Management Lead optimizes the effectiveness of the Wholly Owned & IPA Medical Coding teams. The lead analyzes the performance of the Wholly Owned & IPA Medical Coding teams and creates strategies to maximize associate output.  The lead owns the end-to-end process to continuously improve and create transparency and adherence. The Program Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Relationship Building:

• Cultivate relationships with Wholly Owned & IPA Medical Coding teams and leaders.

• Serve as liaison and primary point of contact with the Wholly Owned & IPA Medical Coding teams.

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 Wholly Owned & IPA Medical Coding processes and quality.

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 or inform 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 Responsibilities:

• 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 or inform 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
 

Required Qualifications

• Bachelor's Degree; any equivalent combination of relevant education, skills, training, and experience.

• A minimum of five years of experience in Program Management

• Ability to lead and/or facilitate a team to motivate and guide program initiatives.

• Coding Certification: preferably CPC/CPMA

• Public speaking & group presentation skills

• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint

• Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.

• Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.

• Ability to work in a rapidly changing, matrixed environment.

• Has a positive, collaborative mindset to foster partnership within and the Coding, Audit, and Education department, the PCO, and Humana

• Possess strong organizational skills to manage time, prioritize tasks, and create a structured system to track task completion for meeting deadlines.

Preferred Qualifications

• Value-based care experience

Additional Information

• Travel up to 20% across PCO markets dependent upon business need 

• Remote Role

Work at Home Statement

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 required; 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 in