Consultative Coding Professional

Become a part of our caring community

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:

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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.

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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