Director, Operational Excellence

Director, Operational Excellence

Become a part of our caring community and help us put health first. The Director, Operational Excellence will lead strategic initiatives to enhance the efficiency, accuracy, and compliance of medical coding operations across the organization. This role is responsible for driving continuous improvement, ensuring regulatory alignment, and fostering a high-performance culture within coding teams. The ideal candidate is a seasoned leader with deep expertise in medical coding, risk adjustment, and operational transformation.

Key Responsibilities

Strategy :

• Develop and execute a roadmap for operational excellence in medical coding.
• Align coding operations with organizational goals, regulatory requirements, and industry best practices.
• Oversee the performance of Coding Educators and Program Managers supporting consultative, onshore, and offshore coding teams.

Quality and Compliance :

Process Optimization :

Team Development :

Cross-Functional Collaboration :

Reporting & Analytics :

Coder Education :

Associate Engagement and Retention :

Minimum Qualifications

Bachelor's degree required. Minimum of five (5) years of progressive experience in operational excellence, medical coding operations, or a related healthcare leadership role. Minimum of five (5) years leadership experience overseeing multifaceted teams. Experience in program management and analytics.

Preferred Certifications

Master's degree preferred. Deep understanding of ICD-10, CPT, and HCPCS coding, with expertise in navigating CMS and HHS regulations. CPC, CCS, or other relevant medical coding certifications preferred.

Required Experience & Skills

Demonstrated experience developing and executing operational strategies within medical coding or healthcare operations. Proven ability to align coding operations with organizational objectives, regulatory requirements (e.g., CMS, HHS), and industry best practices. Track record of leading, managing, and mentoring teams, including Coding Educators and Program Managers, across consultative, onshore, and offshore environments. Experience overseeing coding quality assurance programs and implementing corrective actions and targeted training based on audit outcomes. Strong background in process optimization and promoting a culture of accountability, continuous learning, and operational excellence. Ability to foster team development, drive performance, and support associate engagement and retention. Experience collaborating cross-functionally with clinical, analytics, and compliance teams, and acting as a subject matter expert for coding operations. Proficiency in developing and maintaining dashboards, KPIs, and presenting operational insights to senior leadership. Experience designing and delivering training programs based on audit findings, and addressing coder skill gaps in partnership with analytics and audit teams. Strong conflict resolution and associate relations skills, including conducting feedback sessions, performance evaluations, and career development discussions. Excellent communication, organizational, and analytical skills.

Work at Home Statement

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. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees 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 employees 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. $138,900 - $191,000 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

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 : CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE : HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

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. Centerwell, a wholly owned subsidiary of 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.