Consultative Coding Manager

423 Conviva Care Solutions, LLC; Florida; Hybrid; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Competitive benefits

Job summary

Humana, Inc. is seeking a Consultative Coding Manager to lead a diverse team of consultative coders focused on accurate clinical documentation and coding aligned with disease prevalence.

The role partners with Divisional Coding Leaders to shape market-specific strategies and ensure compliance with policies while collaborating with onshore and offshore teams. The ideal candidate has 6+ years of technical experience, 2+ years of management, and relevant coding certifications (CPC, RHIA, RHIT,

Qualifications

• Bachelor's Degree or equivalent experience.
• 6+ years of technical experience including Microsoft Office Suite.
• 2+ years of management experience.
• CPC Certification.
• RHIA, RHIT, CCS, CPC Certification.
• Medicare Risk Adjustment knowledge.
• This position is market-based; candidates must reside in Florida, Georgia, North Carolina or South Carolina.
• Travel up to ~25%.

Responsibilities

• Cultivate relationships with clinicians to serve as the single point of contact for documentation and coding questions.
• Develop strategy with Divisional Coding Leaders to meet market needs.
• Identify and recommend strategies for improving clinical documentation and coding.
• Establish relationships with offshore coding leadership and oversee continuous quality improvement initiatives.
• Oversee PCO process training and reporting; ensure consistent training across teams.

Skills

Management experience

Stakeholder engagement

Education

Bachelor's degree or equivalent

CPC Certification

RHIA Certification

RHIT Certification

CCS Certification

Tools

Microsoft Office Suite

Job description

Become a part of our caring community The Consultative Coding Manager manages a diverse team of consultative coders responsible for ensuring clinical documentation supports accurate coding and is reflective of the disease prevalence within the population. The Consultative Coding leader partners with the Divisional Coding Leader to develop market-specific strategies to promote accurate clinical documentation, ensures all state, federal and internal policies and procedures are followed, and fosters collaboration within onshore and offshore coding, audit, and education.

Strategy

Cultivate relationships with clinicians (Physicians and Advanced Practice Providers) to serve as the single point of contact for questions and issues relating to documentation and coding. In partnership with Divisional Coding Leaders, develops strategy for consultative coding to ensure market needs are being met. Cultivates relationships with Divisional Coding Leaders, Market Leaders, and Consultative Coders to share knowledge and best practices. Identify and recommend strategies for improving clinical documentation and coding for pre and post visit coding.

Post-Visit/Offshore Coding Collaboration

Establish relationship with post-visit/offshore coding leadership. Develop continuous quality improvement initiatives.

Mergers and Acquisitions

Monitor special handling of mergers and acquisitions. Oversee Problem List clean up (as outlined by compliance). Ensure PCO process training is performed consistently. PCO Process training including but not limited to reporting.

Use your skills to make an impact

Required Qualifications

• Bachelor's Degree or equivalent experience.
• 6+ years of technical experience including Microsoft Office Suite.
• 2+ years of management experience.
• CPC (Certified Professional Coder) Certification.
• RHIA, RHIT, CCS, CPC Certification.
• Medicare Risk Advantage based knowledge and experience.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• This position is market-based, and candidates must currently reside in Florida, Georgia, North Carolina or South Carolina.
• Must be able to travel approximately 25%.
• #LI-CM1

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40 Pay Range

Scheduled Weekly Hours 40

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and 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 and many other opportunities.

About us

Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.

CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.