NOTE: This is a Hybrid role candidate must reside in Houston
Consultative Coder
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.
Required:
3 or more years of technical Medical Coding experience or similar (including IPA and Offshore coding management)
RHIA, RHIT, CCS, or CPC Certification
Must reside in the Houston area
Must be able to travel to assigned clinics 30% of the time or more depending on market needs
Proficient in MS Office Suite (Excel, PowerPoint, etc.), Zoom/Teams
Must be comfortable with being on camera and presenting via Zoom/Teams
Preferred:
Passionate about contributing to an organization focused on continuous improvement.
Proficient verbal and written communication skills
Bilingual (English & Spanish)
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
#LI-MM1
#LI-Hybrid
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.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.
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.
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.