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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.
Location: This is a Hybrid role candidate(s) must reside in South Carolina.
You will report to Director, Medical Coding.
Relationship/Concierge Services:
- Cultivate relationships with clinicians (Physicians and Advanced Practice Providers) to serve as the single 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, assessment, 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. You will determine frequency and sampling methodology)
- Review the encounter for potential missed opportunities.
- Address nonbillable services at the provider level.
- Address documentation deficiencies resulting in not billable services promptly (missing chief complaint, missing time for audio only visits, and missing telehealth platform)
- Work with provide 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 reporting for open notes and addendums, and gap attestation process and performance expectations.
- Train acquired providers on PCO documentation requirements and processes.
Other Responsibilities:
- Lead Special Projects within the Division/Markets
- As requested by Market leaders, perform the following tasks:
- 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.
- 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 Qualifications:
- Three years Medical Coding experience or similar (including IPA and Offshore coding management)
- RHIA, RHIT, CCS, or CPC Certification
- Anticipated location and overnight travel are <30% based on business need
Use your skills to make an impact
Work at Home Statement
To ensure Home or Hybrid Home/Office employees', the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- We require at minimum a download speed of 25 Mbps and an upload speed of 10 Mbps; we suggest a wireless, wired cable or DSL connection.
- Satellite, cellular and microwave connection leadership approves only if used.
- We will provide employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format – HireVue
As part of our hiring process for this opportunity, we will use an interviewing technology called HireVue to enhance our hiring. HireVue allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule.
Alert
Humana value's personal identity protection. Please be aware that we may ask applicants to provide their Social Security Number, if we do not already have it on file., Humana will send an email from Humana@myworkday.com with instructions on how Humana's secure website will add the information into your official application.
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#LI-REMOTE
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, 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 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.