Provider Data Validation (PDV) Manager
$86,300–$118,700 year
RemoteUnited States
Job Summary
Lead a team of 13 associates responsible for provider education, coding quality, compliance, and operational performance within the PDV program. Drive operational excellence through workforce planning, performance management, process improvement, and strategic execution aligned with enterprise risk adjustment goals. Monitor performance metrics, identify risks, and implement data-driven improvement strategies while ensuring equitable workload distribution and maintaining documentation accuracy of 95% or greater. Oversee provider education initiatives that improve coding accuracy and ensure all documentation meets quality, compliance, and audit-readiness standards. Optimize Record Insights workflows and partner across the organization to support risk adjustment strategy and operational transformation.
Required Qualifications
- CRC, CPC, CCS, or equivalent medical coding certification
- 2+ years of leadership experience in healthcare operations, risk adjustment, coding, provider education, compliance, or a related field
- Bachelor's degree or equivalent combination of education and experience
- Proficiency with Excel, Power BI, and data analytics tools
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps
- Wireless, wired cable or DSL connection
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
- Occasional travel to Humana's offices for training or meetings
Desired Qualifications
- Experience in Risk Adjustment, Provider Data Validation, Medical Coding, Provider Education, or Healthcare Compliance
- Knowledge of CMS risk adjustment programs, audit methodologies, and regulatory requirements
- Experience leveraging automation, analytics, or AI technologies to improve operational performance
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