IPA Manager Consultative Coding

The Manager, IPA Consultative Medical Coding leads a team of consultative coders supporting value-based care delivery across a defined geographic region. You will oversee regional coding operations to ensure agreement on provider engagement, risk adjustment accuracy, and documentation excellence. You will guide the transition from a retrospective coding model to a that strengthens clinical documentation and coding performance.

Your success requires strong leadership and technical expertise to address complex operational challenges, accomplish regional strategy, and deliver results aligned with organizational goals. This includes monitoring coding staff workload and redistributing resources as needed to meet market operational demands, developing KPIs to monitor the performance of the consultative coding team, tracking and monitoring responses to provider questions for consistency, and analyzing trends to identify opportunities for improved documentation and coding.

• Provide leadership and operational oversight for a team of IPA Consultative Coders within an assigned region
• Accountable for regional coding performance, provider engagement, and risk adjustment outcomes
• Align coding operations with market-specific provider needs, growth strategies, and membership trends
• Partner with Provider Engagement leadership to ensure coordinated support and a consistent provider experience
• Collaborate with STARS leaders and champions to identify STARS gaps and deficiencies

• Lead implementation of the Consultative Coding Model, transitioning from retrospective workflows to longitudinal provider support
• Ensure delivery of:

• Quarterly provider chart reviews
• Real-time coding support through a daily helpdesk
• Provider education on coding accuracy and documentation standards

• Analyze trends, triage, and answer questions in real-time
• Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues
• Increase adoption and optimization of coding tools, including APD 2.0, Stellar, Healow, and MRA 4.0 (POCA)

• Lead, coach, and develop a high-performing team of consultative coders
• Establish expectations for provider engagement, coding quality, and productivity
• Support hiring, onboarding, and workforce planning with care for regional demand
• Promote a culture of accountability, learning, and clinical excellence

• Ensure compliance with ICD-10-CM, HCC guidelines, and CMS risk adjustment methodologies
• Oversee quality outcomes from chart reviews and coding audits
• Identify documentation gaps and implement targeted education programs
• Partner with Coding Excellence and Compliance to maintain regulatory adherence

• Translate organizational goals into regional plans, goals, and performance metrics
• Monitor and report on Indicators including coding accuracy, recapture rates, provider engagement, and efficiency
• Address workflow inefficiencies, coverage gaps, and provider needs through targeted problem-solving
• Support programs across analytics, technology, and operations

• Bachelor's Degree or 5+ years of relevant risk adjustment coding experience within a healthcare setting
• 3+ years of leadership or management experience
• Certified Professional Coder (CPC) or equivalent certification (RHIA, RHIT, CRC or CCS)

• Expertise in risk adjustment, HCC coding, and CMS guidelines
• Experience in provider-facing coding education, documentation improvement, or clinical engagement. Must be passionate about contributing to an organization focused on improving consumer experiences
• Experience supporting value-based care models or IPA/MSO environments
• Experience leading field-based or hybrid teams

This role requires an in-center presence, involving daily commute to assigned clinic(s) and occasional (quarterly) travel within the market to alternative clinic(s) for strategic meetings.

• Workstyle: Hybrid/remote
• Location: Must reside within the state of Florida
• Hours: Monday–Friday, 8:00 AM–5:00 PM; additional time may be required.

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.

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 required; wireless, wired cable or DSL connection is suggested.

In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.

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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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