Consultative Coding Professional - Hybrid

CenterWell • Louisiana, MS

7h • 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 the candidate(s) must reside in Louisiana/Mississippi/Texas. The role reports to the Manager, Medical Coding. The position involves cultivating relationships with clinicians, identifying documentation improvement areas, and partnering with clinical and coding education to deliver education related to improvement opportunities. It also includes analyzing trends, assessing issues, and providing real-time answers, as well as researching and interpreting coding guidelines. Key responsibilities extend to performing Quality Assurance on post-visit reviews, identifying missed opportunities, and addressing nonbillable services and documentation deficiencies promptly. The role also involves working with providers on documentation updates and process changes. For Mergers & Acquisitions, the professional is responsible for problem list cleanup, PCO Process training (including reporting for open notes, addendums, and gap attestation), and training acquired providers on PCO documentation requirements. Additional responsibilities include leading special projects, analyzing AWV completion rates and EDAPS, conducting chart reviews for educational opportunities, performing individual chart research, collaborating with HEDIS leaders to identify gaps, and participating in Payer calls/chart reviews to compile findings and ensure accurate data submission. CenterWell Senior Primary Care, a part of Humana, focuses on proactive, preventive care for seniors through a unique care model that emphasizes personalized experiences and integrated care teams, aiming for better health outcomes by addressing physical, emotional, and social wellness.

Requirements

• Three years Medical Coding experience or similar (including IPA and Offshore coding management).
• RHIA, RHIT, CCS, or CPC Certification.
• Ability to travel both locally and overnight based on business need.
• Must reside in LA/MS/TX.
• Self-provided internet service must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps; a wireless, wired cable or DSL connection is suggested (Satellite, cellular and microwave connection only if leadership approves).
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Responsibilities

• Provide medical coding expertise to support clinical staff (Physicians and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding.
• Cultivate relationships with clinicians (Physicians and Advanced Practice Providers) to serve as the single contact for questions and issues relating to documentation and coding.
• Identify documentation improvement areas based on one-on-one engagement with clinicians.
• 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 (determine frequency and sampling methodology).
• 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) for Mergers & Acquisitions.
• Conduct PCO Process training including reporting for open notes and addendums, and gap attestation process and performance expectations for Mergers & Acquisitions.
• Train acquired providers on PCO documentation requirements and processes for Mergers & Acquisitions.
• Lead Special Projects within the Division/Markets.
• Analyze AWV completion rates (what criteria is needed to complete AWV) as requested by Market leaders.
• Analyze EDAPS; report the variances between datahub and eCW as requested by Market leaders.
• Conduct Chart reviews to identify educational opportunities as requested by Market leaders.
• Perform individual chart research as requested by Market leaders.
• 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 benefits
• Dental benefits
• 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 disability
• 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 the state of 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