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The Medical Coding Professional extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. You will work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. You will report to a Medical Coding Manager.
Consultative Coder
You will provide 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 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.
- Review the encounter for potential missed opportunities.
- Address nonbillable services at the provider level.
- Address documentation deficiencies resulting in not billable services (missing chief complaint, missing time for audio only visits, and missing telehealth platform)
- Serve as liaison to 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 :
- 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.
Must reside in San Antonio area
Use your skills to make an impact
Required Qualifications:
- 3+ years of Medical Coding experience or similar (including IPA and Offshore coding management)
- RHIA, RHIT, CCS, or CPC Certification
Preferred Qualifications:
- Have 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.
Additional Information
- Hybrid role: Work from home and occasionally use Humana office space for collaboration and other face-to-face needs.
- Standard working hours required; 8:00 am - 5:00 pm; Central Time Zones
- Location: You will support the San Antonio market. It is required that you reside in San Antonio.
- 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
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 Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' 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.