Consultative Coding Professional

CenterWell • Carolina, NC

3d • Remote

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 role involves building strong relationships with physicians and advanced practice providers, serving as their primary point of contact for documentation- and coding-related questions and concerns. Through one-on-one engagement with clinicians, the Consultative Coder identifies opportunities to improve documentation and partners with the clinical and coding education teams to deliver targeted training. They analyze trends, triage, and answer questions in real-time, researching and interpreting correct coding guidelines and internal business rules. The role also includes performing Quality Assurance on post-visit reviews, reviewing encounters for potential missed opportunities, addressing non-billable services at the provider level, and addressing documentation deficiencies. The Consultative Coder serves as a liaison to provide timely updates on documentation requirements and process changes. Additionally, this role is responsible for the special handling of Mergers & Acquisitions, including conducting PCO Process training, training acquired providers on PCO documentation requirements, summarizing and analyzing AWV completion rates, collaborating with HEDIS leaders to identify gaps, and participating in Payer calls/chart reviews and meetings to ensure accurate data submission.

Requirements

• 3 or more years of technical Medical Coding experience or similar (including IPA and Offshore coding management)
• RHIA, RHIT, CCS, or CPC Certification
• Ability to travel both locally and overnight.
• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint
• 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
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Responsibilities

• Build strong relationships with physicians and advanced practice providers, serving as their primary point of contact for documentation- and coding-related questions and concerns.
• Identify opportunities to improve documentation through one-on-one engagement with clinicians.
• Partner with clinical and coding education teams to deliver targeted training.
• 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 non-billable 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.
• 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.
• Summarize and analyze AWV completion rates (what criteria is needed to complete AWV).
• 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
• vision
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, 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