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 ****

Company info

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