Humana · 1 day ago
Manager, Risk Adjustment
United States
Full-time
Remote
Mid, Senior Level
$86K/yr - $119K/yr
4+ years expHumana Inc. is committed to putting health first, and they are seeking a Manager, Risk Adjustment to conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes. This role involves supervising a team, ensuring coding accuracy, and maintaining compliance with state and federal regulations.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Conduct quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to CMS and other government agencies
Apply advanced technical knowledge to solve moderately complex problems
Receive assignments in the form of objectives and determine approach, resources, schedules and goals
Perform escalated or more complex work of a similar nature and supervise a group of typically support and technical associates
Coordinate and provide day-to-day oversight to associates
Ensure consistency in execution across the team
Hold team members accountable for following established policies
Ensure coding is accurate and properly supported by clinical documentation within the health record
Follow state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records
Participate in provider education programs on coding compliance
Make decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area
Require cross departmental collaboration and conduct briefings and area meetings; maintain frequent contact with other managers across the department
Qualification
Required
4 or more years of technical experience
Strong knowledge of ICD-9/10 diagnosis codes
Previous experience working in a managed care field
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Ability to travel up to 20% of the time within region
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Bachelor's Degree
CPC (Certified Professional Coder) Certification
2 or more years of management/supervisory experience
Progressive business consulting and/or operational leadership experience
Proficiency in analyzing and interpreting data trends
Comprehensive knowledge of Medicare policies, processes and procedures
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
2026-01-07
2026-01-06
2026-01-04
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