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The Consultative Coder provides medical coding expertise to support clinical staff (Physicians and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding.
Relationship/Concierge Services:
- Clinician Relationships and Support: Build strong relationships with physicians and advanced practice providers, serving as their primary point of contact for documentation- and coding-related questions and concerns.
- Documentation Improvement and Education: Through one-on-one engagement with clinicians, identify opportunities to improve documentation and partner with the clinical and coding education teams to deliver targeted training.
- 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.
Post-Visit/Offshore Coding Collaboration:
- Perform Quality Assurance on post-visit reviews. (Frequency and sampling methodology to be determined)
- Review the encounter for potential missed opportunities.
- Address nonbillable services at the provider level.
- Address documentation deficiencies resulting in not billable services in a timely manner (missing chief complaint, missing time for audio only visits, and missing telehealth platform)
- Serve as liaison to provide timely updates on documentation requirements and process changes.
Mergers and Acquisitions:
- Responsible for the special handling of Mergers & Acquisitions:
- Conduct PCO Process training including but not limited to reporting for open notes and addendums, and gap attestation process and performance expectations.
- Train acquired providers on PCO documentation requirements and processes.
- Summarize and analyze AWV completion rates ( what criteria is needed to complete AWV)
- Collaborate with HEDIS leaders and champions to identify HEDIS gaps and deficiencies.
- Participate in Payer calls/chart reviews.
- Compile payer findings and assist with research. Participate in payor meetings/discussions to ensure accurate data submission.
Work Environment:
This position requires both local and overnight travel dependent upon business needs.
Use your skills to make an impact
Qualifications:
- 3 or more years of technical Medical Coding experience or similar (including IPA and Offshore coding management)
- RHIA, RHIT, CCS, or CPC Certification
- Ability to travel both locally and overnight.
Knowledge, Skills, and Abilities:
- Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint
- Ability to communicate effectively and sensitively with clinicians and team members in stressful situations.
- Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.
- Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.
- Ability to work in a rapidly changing, matrixed environment.
- Has a positive, collaborative mindset to foster partnership within and the Coding, Audit, and Education department, the PCO, and Humana
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.
$59,300 - $80,900 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.
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 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). Learn more about what we offer at CenterWell.com.
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.
