Consultative Coding Professional

CenterWell • San Antonio, TX

2d • Hybrid

About The Position

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. Assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This role 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. The role involves cultivating relationships with clinicians 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. 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. 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. 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.

Requirements

• 3+ years of Medical Coding experience or similar (including IPA and Offshore coding management)
• RHIA, RHIT, CCS, or CPC Certification
• Must reside in San Antonio area

Nice To Haves

• 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.

Responsibilities

• Extracts clinical information from medical records and assigns appropriate procedural terminology and medical codes.
• Provides medical coding expertise to support clinical staff.
• Cultivates relationships with clinicians to serve as the single contact for documentation and coding questions.
• Identifies documentation improvement areas and partners with clinical and coding education.
• Analyzes trends, triages, and answers coding-related questions in real-time.
• Researches and interprets correct coding guidelines and internal business rules.
• Performs Quality Assurance on post-visit reviews.
• Reviews encounters for potential missed opportunities.
• Addresses non-billable services and documentation deficiencies at the provider level.
• Serves as a liaison for updates on documentation requirements and process changes.
• Handles special projects related to Mergers & Acquisitions, including problem list cleanup and PCO process training.
• Analyzes AWV completion rates and EDAPS variances.
• Conducts chart reviews to identify educational opportunities.
• Collaborates with HEDIS leaders to identify gaps and deficiencies.
• Participates in payer calls, chart reviews, and meetings to ensure accurate data submission.

Benefits

• medical
• dental
• 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

What This Job Offers

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