Clinical Support Team Senior Consultation/Partnership

Profile

Description

The Senior Market Consultation/Partnership Professional promotes and improves the quality and measurement of care delivery programs with a market(s). The Senior Market Consultation/Partnership Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Be part of our Clinical Support Team - Humana is seeking a Clinical Consultant who will be accountable for developing and maintaining key relationships and work with assigned area to optimize business results.

Humana is seeking a Clinical Consultant - Certified Medical Coder to join the Clinical Support Team within the Healthcare Quality Reporting & Improvement department. Duties will include:

Help ensure accurate review of medical records for Medicare and Commercial Risk Adjustment purposes

Review and respond to appeals to determine the final outcome when discrepancies in coding interpretation are identified

Provide support for establishment and monitoring of Humana's medical coding communication efforts to promote accurate and complete documentation

Recommend and review medical coding related education for medical record documentation guidelines

Review and respond to results from medical record audits as necessary

Develop and maintain coding guidelines and policies related to diagnosis coding to ensure compliance with ICD-10-CM guidelines and industry standards and educate associates on these guidelines and policies

Keep current on all governmental medical and legal issues specific to coding and compliance

Research and respond to coding inquiries from Humana coders

Support and participate in process and quality improvement initiatives.

Interact with and support a multidisciplinary clinical outcomes team involved in ensuring that HQRI initiatives result in the highest quality of member care.

Work collaboratively with business partners to ensure a strong understanding of coding and documentation amongst Humana's coders.

Role Essentials

Nursing degree or clinical degree

Certified Medical Coder with one of the following active certifications and with a high degree of competency:

CPC - Certified Professional Coder (AAPC)

COC - Certified Outpatient Coder (AAPC)

CIC - Certified Inpatient Coder (AAPC)

CRC - Certified Risk Adjustment Coder (AAPC)

CCA - Certified Coding Associate (AHIMA)

CCS - Certified Coding Specialist (AHIMA)

CCS-P - Certified Coding Specialist - Physician based (AHIMA)

Proficient with use of ICD-10-CM Coding Manual

Experience in completing efficient health-related research, with associated analysis and conclusions

Working knowledge of HEDIS, Stars, and other clinical quality measures

Basic PC skills (including Microsoft Office - Word, PowerPoint and Excel) required.

Experience with technical writing

Excellent communication skills, both written and verbal plus effective listening

Strong organizational skills

Interpersonal skills

Self-management, responsibility and accountability

Attention to detail

Strong analytical skills

Role Desirables

Working knowledge or experience with Medicare and/or Commercial risk adjustment

Prior experience in a role/s within a medical office or facility environment

Experience with medical records, both paper and electronic for reviewing records

Experience with American Hospital Association Coding Clinic, Official Guidelines for Coding and Reporting, and CMS risk adjustment regulations

Reporting Relationships

This area is under the leadership of the Assistant Vice President of Risk Adjustment Compliance within the Healthcare Quality Reporting & Improvement department

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com