IPA Consultative Coding Manager

About the role

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 one that strengthens clinical documentation and coding performance.

Responsibilities

• 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)

Requirements

• 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)

Preferred Qualifications

• Expertise in risk adjustment, HCC coding, and CMS guidelines
• Experience in provider-facing coding education, documentation improvement, or clinical engagement
• 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

Qualifications

• Use your skills to make an impact
• Required Qualifications: 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)
• Preferred Qualifications: Expertise in risk adjustment, HCC coding, and CMS guidelines, Experience in provider-facing coding education, documentation improvement, or clinical engagement, 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

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Paid time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Lifetime accident and critical illness insurance
• Life insurance
• Flexible spending accounts
• Employee assistance program
• Discounted gym memberships
• Volunteer time off
• Professional development opportunities
• Work-life balance initiatives

About Us

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM).