IPA Consultative Coder
About The Position
The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify STARS gaps and deficiencies. The IPA Consultative Coding Professional provides medical coding expertise to support IPA-affiliated clinicians—including physicians and advanced practice providers—to ensure documentation supports accurate diagnostic coding and risk adjustment capture.
Requirements
- 3+ years of risk adjustment Medical Coding or risk adjustment Provider Education
- Intermediate/advanced competency with MS Office based programs (Excel, Word, PowerPoint)
- Must be certified at least one of the following: CCS, CRC, or CPC
- Must reside and be able to travel within the assigned MSO market or region.
Nice To Haves
- Strong communication and interpersonal skills are essential. These skills enable effective, clear, and sensitive engagement with clinicians and team members, even in high-pressure or stressful situations. They also facilitate presenting, influencing, and building credibility at all levels of the organization.
- Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and Education, PCO, and Humana teams.
Responsibilities
- Be the primary contact for assigned IPA providers for all coding and documentation-related inquiries.
- Build consultative relationships with providers to support continuous improvement in coding accuracy and documentation practices.
- Deliver targeted education based on provider-specific trends and opportunities identified through chart reviews and coding analytics.
- Conduct quarterly chart reviews for assigned providers to evaluate coding accuracy, documentation integrity, and risk capture opportunities.
- Develop and deliver comprehensive education based on findings, including documentation best practices and coding optimization strategies.
- Identify trends and recurring gaps, and partner with education and leadership teams to address systemic opportunities.
- Support daily operations of internal coding solutions, including Annual Proof of Documentation (APD 2.0) and any future tools implemented based on organizational needs.
- Assist providers in navigating coding workflows, resolving issues, and ensuring successful use of coding tools.
- Monitor and support completion of coding activities tied to assigned providers.
- Participate in a daily coder helpdesk (virtual/Zoom-based), providing real-time support to providers within assigned markets.
- Address immediate coding and documentation questions, ensuring accurate guidance.
- Maintain a high level of responsiveness and provider engagement.
- Support HCC outage management through structured reviews of “assessed but not coded” conditions.
- Conduct targeted reviews to identify missed coding opportunities and provide education to improve recapture performance.
- Collaborate with analytics and leadership teams to track and improve performance outcomes.
Benefits
- medical
- dental
- vision benefits
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
