Quality Assurance Manager

Humana; Town of Texas (WI); Remote; USD 104,000 - 143,000; Full time

Job summary

A leading healthcare organization is seeking a Manager, Quality Assurance to ensure high standards in coding practices and quality improvement. This role involves leading initiatives, training staff, and making strategic decisions aligned with compliance. The ideal candidate has significant experience in medical coding and leadership, coupled with strong analytical and communication skills. Join us to make a meaningful impact in the quality of care provided.

Benefits

Medical, dental and vision benefits

401(k) retirement savings plan

Paid parental and caregiver leave

Qualifications

• Minimum 7 years of experience in medical coding, audit, and compliance.
• At least 1 year of experience in Payment Integrity or vendor management.
• Experience conducting quality audits preferred.

Responsibilities

• Develop policies and procedures to monitor coding accuracy.
• Lead quality assurance initiatives to ensure compliance.
• Provide training and coaching on quality improvement techniques.

Skills

Strong analytical and decision-making skills

Excellent communication and presentation skills

Experience leading virtual teams

Education

Medical coding certification (AAPC or AHIMA)

Bachelor's degree or 5+ years of leadership experience

Job description

Overview

Become a part of our caring community and help us put health first. The Manager, Quality Assurance develops and implements programs to establish and maintain quality standards of existing products and services, as well as developing programs to focus employees on the quality of care given to patients. The Manager, Quality Assurance works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Quality Assurance plays a pivotal role in ensuring coding accuracy, elevating quality standards, and driving process improvement initiatives within the Payment Integrity organization and Vendor Partners. This position is responsible to collaborate and support coding programs within our internal department and our vendor partners. Will support and promote consistent, compliance, and high-quality medical coding practices, with a strong focus collaboration and quality enhance thru education.

Key Responsibilities

• Develops and refines policies, procedures, and methodologies to monitor and improve coding accuracy and operational quality across internal teams and vendor partners.
• Leads quality assurance initiatives aimed at identifying coding discrepancies, improving audit outcomes, and ensuring compliance with regulatory and contractual standards.
• Designs and implements process improvement strategies to enhance efficiency, reduce errors, and optimize coding workflows across the Payment Integrity ecosystem.
• Provides training and coaching to staff and vendor leadership on quality improvement techniques, coding standards, and documentation best practices.
• Maintains ongoing communication with medical staff, vendor partners, and internal stakeholders to share QA insights and foster continuous improvement.
• Makes strategic decisions regarding resource allocation, project execution, and operational priorities in alignment with Payment Integrity goals.
• Facilitates cross-functional collaboration and leads meetings to ensure transparency and alignment across internal and external teams.
• Oversees virtual team engagement, including remote training sessions, vendor performance reviews, and audit feedback loops.

Required Qualifications

• Medical coding certification (AAPC or AHIMA)
• Minimum 7 years of experience in medical coding, audit, and CMS and coding compliances
• Bachelor’s degree or 5+ years of leadership experience
• At least 1 year of experience in Payment Integrity or vendor management
• Strong analytical and decision-making skills
• Excellent communication and presentation skills
• Experience leading virtual teams and conducting remote training

Preferred Qualifications

• Experience conducting quality audits and identifying performance metrics
• Background in compliance and risk mitigation strategies
• Demonstrated success in process improvement and operational efficiency initiatives

Additional Information

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
• Associates 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 associates 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.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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.