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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:
Cultivate relationships with clinicians (Physicians and Advanced Practice Providers) to serve as the single point of contact for questions and issues relating to documentation and coding.
Based on one-on-one engagement with clinicians, identify documentation improvement areas and partner with clinical and coding education to deliver education related to improvement opportunities
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:
Perform Problem list cleanup (as outlined by compliance)
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.
Other Duties:
Lead Special Projects within the Division/Markets
As requested by Market leaders, perform the following duties:
Summarize and analyze AWV completion rates ( what criteria is needed to complete AWV)
Analyze EDAPS; report the variances between datahub and eCW.
Conduct Chart reviews to identify educational opportunities.
Perform individual chart research as requested.
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.
**Incumbent must reside in North Carolina area
Use your skills to make an impact
Required Qualifications:
A minimum of three years Medical Coding experience or similar (including IPA and Offshore coding management)
RHIA, RHIT, CCS, or CPC Certification
Preferred Qualifications:
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
Passionate about contributing to an organization focused on continuous improvement.
Proficient verbal and written communication skills
Public speaking / group presentation skills
Additional Information
Remote Role
Standard working hours required; 8:00 am - 5:00 pm; Eastern Time Zones
Location:This role will support the North Carolina market. It is required that the incumbent reside in North Carolina.
Anticipated location and overnight travel is <30% based on business need
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.
Scheduled Weekly Hours
40Pay 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 yearThis 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.
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