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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
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
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay 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 year
This 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 I
