Quality Assurance Manager

Manager, Quality Assurance

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 on collaboration and quality enhancement through 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.

Use your skills to make an impact

Required Qualifications :

Preferred qualifications :

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 :

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. 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 https : / / www.humana.com / legal / accessibility-resources?source=Humana_Website.