Consultative Coding Professional

CenterWell

22h • Hybrid

About The Position

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. This is a Hybrid role, and candidate(s) must reside in South Carolina. The position reports to the Director, Medical Coding. CenterWell Senior Primary Care focuses on providing proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, and minor injury treatment. Their care model emphasizes personalized experiences, taking time to listen, learn, and address factors impacting patient well-being. Integrated care teams, comprising physicians, nurses, and behavioral health specialists, spend more time with patients to deliver compassionate, personalized care and better health outcomes, addressing both physical and social wellness. CenterWell, a Humana company, is a leading healthcare services business dedicated to creating integrated and differentiated experiences that prioritize patients, resulting in accessible, comprehensive, and personalized high-quality healthcare. As the largest provider of senior-focused primary care, a leading provider of home healthcare, and an integrated home delivery, specialty, hospice, and retail pharmacy, CenterWell focuses on the whole health of its patients.

Requirements

• Three years Medical Coding experience or similar (including IPA and Offshore coding management).
• RHIA, RHIT, CCS, or CPC Certification.
• Self-provided internet service must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps (wireless, wired cable or DSL connection suggested; satellite, cellular and microwave connection only with leadership approval).
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Responsibilities

• 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, assessment, 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.
• Review the encounter for potential missed opportunities.
• Address nonbillable services at the provider level.
• Address documentation deficiencies resulting in not billable services promptly (missing chief complaint, missing time for audio only visits, and missing telehealth platform).
• Work with provide updates on documentation requirements and process changes.
• 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.
• Lead Special Projects within the Division/Markets.
• 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.

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
• Bonus incentive plan (based upon company and/or individual performance)
• Bi-weekly payment for internet expense (for employees who live and work from Home in California, Illinois, Montana, or South Dakota)
• Telephone equipment appropriate to meet the requirements for their position/job

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed