Senior Market Consultation/Partnership Professional

at Humana in Rogers, Arkansas, United States

Job 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.


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


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Job Posting: JC178058595

Posted On: Feb 18, 2021

Updated On: Mar 26, 2023

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