at Humana in Rogers, Arkansas, United States
Job Description
Description
The Senior Market Consultation/Partnership Professional promotes and improves the quality and measurement of care delivery programs with a market(s). The Senior Market Consultation/Partnership Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Responsibilities
Be part of our Clinical Support Team – Humana is seeking a Clinical Consultant who will be accountable for developing and maintaining key relationships and work with assigned area to optimize business results.
Humana is seeking a Clinical Consultant – Certified Medical Coder to join the Clinical Support Team within the Healthcare Quality Reporting & Improvement department. Duties will include:
+ Help ensure accurate review of medical records for Medicare and Commercial Risk Adjustment purposes
+ Review and respond to appeals to determine the final outcome when discrepancies in coding interpretation are identified
+ Provide support for establishment and monitoring of Humana’s medical coding communication efforts to promote accurate and complete documentation
+ Recommend and review medical coding related education for medical record documentation guidelines
+ Review and respond to results from medical record audits as necessary
+ Develop and maintain coding guidelines and policies related to diagnosis coding to ensure compliance with ICD-10-CM guidelines and industry standards, and educate associates on these guidelines and policies
+ Keep current on all governmental medical and legal issues specific to coding and compliance
+ Research and respond to coding inquiries from Humana coders
+ Support and participate in process and quality improvement initiatives.
+ Interact with and support a multidisciplinary clinical outcomes team involved in ensuring that HQRI initiatives result in the highest quality of member care.
Required Qualifications
+ Nursing degree or healthcare certification(ex: Medical Assistant, Clinical certification etc) with relevant work experience
+ Certified Medical Coder with one of the following active or in-progress certifications and with a high degree of competency:
+ CPC – Certified Professional Coder (AAPC)
+ COC – Certified Outpatient Coder (AAPC)
+ CIC – Certified Inpatient Coder (AAPC)
+ CRC – Certified Risk Adjustment Coder (AAPC)
+ CCA – Certified Coding Associate (AHIMA)
+ CCS – Certified Coding Specialist (AHIMA)
+ CCS-P – Certified Coding Specialist – Physician based (AHIMA)
+ Proficient with use of ICD-10-CM Coding Manual
+ Experience in completing efficient health-related research, with associated analysis and conclusions
+ Working knowledge of HEDIS, Stars, and other clinical quality measures
+ Basic PC skills (including Microsoft Office – Word, PowerPoint and Excel) required.
+ Experience with technical writing
+ Excellent communication skills, both written and verbal plus effective listening
+ Strong organizational skills
+ Interpersonal skills
+ Self-management, responsibility and accountability
+ Attention to detail
+ Strong analytical skills
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
+ Working knowledge or experience with Medicare and/or Commercial risk adjustment
+ Prior experience in a role/s within a medical office or facility environment
+ Experience with medical records, both paper and electronic for reviewing records
+ Experience with American Hospital Association Coding Clinic, Official Guidelines for Coding and Reporting, and CMS risk adjustment regulations
Additional Information
Scheduled Weekly Hours
40
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