Consultative Coding Manager

Conviva Care Solutions; United States; Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical benefits (medical, dental, and

Vision benefits

401(k) retirement savings plan

Paid time off

Disability insurance

Life insurance

Job summary

Conviva Senior Primary Care seeks a Consultative Coding Manager to lead a diverse team ensuring documentation supports accurate coding and reflects disease prevalence. You will align with market needs, collaborate with onshore/offshore teams, and drive continuous improvement in coding practices. The role requires strong leadership, CPC/RHIA/RHIT/CCS certifications, and willingness to travel approx.

25%. The position is remote, offering engagement with multiple markets and ongoing professional

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 and experience.
• Passionate about contributing to an organization focused on improving consumer experiences.
• Candidates must reside in Florida, Georgia, North Carolina or South Carolina.
• Ability to travel approximately 25%.

Responsibilities

• Cultivate relationships with clinicians to serve as the single point of contact for questions and issues relating to documentation and coding.
• Develop strategy for consultative coding with Divisional Coding Leaders to meet market needs.
• Cultivate 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.
• Establish relationship with post-visit/offshore coding leadership and develop continuous quality improvement initiatives.
• Monitor mergers and acquisitions and oversee PCO process training and reporting.

Skills

Leadership

Travel willingness

Education

Bachelor’s Degree or equivalent experience

CPC Certification

RHIA

RHIT

CCS

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

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

About Conviva Senior Primary Care: 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.

About CenterWell, a Humana company: 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