The consultative coder confirms appropriate diagnosis and procedural code assignment. Analyzes, enters, and manipulates database. Responds to or clarifies internal requests for coding and/or documentation related information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for provider support and workflow processes, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.Consultative Coder
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:
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.
Must be willing to proactively schedule and conduct regular on-site coding and documentation support for assigned centers and providers
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 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.
Other Duties:
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
**Incumbent must reside in Palm Beach County
**Hybrid role: Incumbent will work remotely; but will be required to visit centers based on the business need (i.e. every other week).
Use your skills to make an impact
Required Qualifications
A minimum of three years of technical Medical Coding, focused on outpatient (risk adjustment) coding.
RHIA, RHIT, CCS, or CPC Certification
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
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint
Ability to travel both locally and overnight.
Preferred Qualifications
Excellent public speaking / group presentation skills
Additional Information
Hybrid role: Incumbent will work remotely; but will be required to visit centers based on the business need (i.e. every other week).
Incumbent must reside in Palm Beach County
Standard working hours required; 8:00 am - 5:00 pm.
Anticipated local and overnight travel is