Humana · 2 months ago
Program Management Lead, Offshore Coding Operations
United States
Full-time
Remote
Senior Level
$104K/yr - $143K/yr
5+ years expHumana is a healthcare company focused on providing quality care to its patients. The Program Management Lead, Offshore Coding Operations is responsible for optimizing the offshore coding team's performance, conducting quality assurance audits, and developing strategies for continuous improvement in coding processes.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Conduct 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
Optimize the effectiveness of the offshore coding (post-visit) team
Analyze the performance of the offshore coding team and create strategies to maximize associate output
Cultivate relationships with onshore and offshore coding teams including leaders
Serve as liaison and primary point of contact with the offshore (vendor) leaders
Advise coding leaders to develop functional strategies (often segment specific) on matters of significance
In partnership with Coding Operational Excellence and Regional Coding Leaders, develop strategies for continuous improvement of offshore coding processes and quality
Partner with analytics to develop quality assurance program on post-visit reviews
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
Follow state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records
Partner with coding teams (consultative coders) on the special handling of Mergers & Acquisitions
Lead Special Projects for onshore and offshore coding teams
Participate in chart reviews to identify educational opportunities
Conduct research as needed
Participate in Payer calls/chart reviews
May participate in provider education programs on coding compliance
Exercise independent judgment and decision making on complex issues regarding job duties and related tasks, and work under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action
Qualification
Required
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
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
Preferred
Master's degree preferred
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-09
2026-01-07
2026-01-06
Company data provided by crunchbase