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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 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: 07-04-2025

About us

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s 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 Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources