The Provider Data Validation (PDV) Manager leads a team of 13 associates responsible for provider education, coding quality, compliance, and operational performance within the PDV program. This leader drives operational excellence through workforce planning, performance management, process improvement, and strategic execution aligned with enterprise risk adjustment goals.
The role partners closely with PDV peers, operational, and technology stakeholders to enhance provider outcomes, improve data quality, and advance scalable solutions through analytics, automation, and innovation while ensuring regulatory compliance and audit readiness.
Key Responsibilities
- Lead, coach, and develop a high-performing team of 13 associates.
- Drive operational excellence through workflow optimization, inventory management, and resource planning.
- Monitor performance metrics, identify risks, and implement data-driven improvement strategies.
- Ensure equitable workload distribution while maintaining productivity, quality, and associate engagement.
- Foster a culture of accountability, collaboration, adaptability, and continuous improvement.
- Oversee provider education initiatives that improve coding accuracy, documentation integrity, and provider engagement.
- Ensure education documentation meets quality, compliance, and audit-readiness standards.
- Maintain quality performance targets, including documentation accuracy of 95% or greater.
- Ensure the successful execution and completion of annual coding and provider education initiatives
- Optimize Record Insights (RI) workflows and operational processes.
- Partner across the organization to support risk adjustment strategy and operational transformation.
Success Measures
- Deliver operational excellence through effective resource management and sustained productivity.
- Achieve and maintain documentation quality standards of 95% or greater.
- Successfully execute annual provider education and coding initiatives within established timelines.
- Build and sustain an engaged, collaborative, and high-performing team culture.
- Drive measurable improvements through data analytics, process optimization, and AI-enabled innovation.
Use your skills to make an impact
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.
Preferred 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.
Work at Home 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.
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.
$86,300 - $118,700 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 08-21-2026
