Consultative Coding Professional

Become a part of our caring community 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