[Remote] Consultative Coding Professional

Note: The job is a remote job and is open to candidates in USA. Humana is a healthcare company that focuses on providing proactive and preventive care. The Consultative Coding Professional will provide medical coding expertise to support clinical staff, ensuring that documentation within medical records supports diagnostic and procedural coding while cultivating relationships with clinicians and addressing documentation deficiencies.

Responsibilities

• 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.
• 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.
• 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.
• 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.

Skills

• A minimum of three years Medical Coding experience or similar (including IPA and Offshore coding management)
• RHIA, RHIT, CCS, or CPC Certification
• Ability to travel both locally and overnight.
• 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

Benefits

• 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

Company Overview

Company H1B Sponsorship