IPA Consultative Coder - North Florida (Orlando)

CenterWell Senior Primary Care; Orange City (FL); Hybrid; USD 59,300 - 80,300; Full time

Job summary

Humana's IPA Consultative Coding Professional role in Orange City, FL, provides expert coding guidance to IPA affiliates nationwide to improve risk adjustment and value-based care. You will analyze trends, answer questions, and deliver provider education on documentation standards.

You will manage a provider panel, deliver targeted education, monitor coding workflows, and support ongoing education sessions while collaborating with STARS leaders to close gaps.

Qualifications

• 3+ years of risk adjustment medical coding or risk adjustment provider education.
• Must hold CCS, CRC, or CPC certification.
• Willingness to travel within the assigned MSO market or region (Orange City, FL 32763).

Responsibilities

• Be the primary contact for assigned IPA providers for all coding and documentation inquiries and deliver consultative support.
• Conduct quarterly chart reviews to evaluate coding accuracy and risk capture opportunities, and deliver education.
• Support daily operations of internal coding solutions and assist providers in navigating coding workflows.

Skills

Risk adjustment coding

Education

CCS or CRC or CPC certification

Tools

MS Office

Job description

Overview

Become a part of our caring community and help us put health first.

The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide, including MSO‑contracted independent providers. As the primary coding and documentation resource for assigned providers, you will support accuracy, compliance, and performance in risk adjustment and value‑based care initiatives. You will analyze trends, triage, and answer questions in real‑time, research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.

As an IPA Consultative Coding Professional, you will be assigned 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.

Location: Orange City, FL 32763

Relationship Management and Provider Support

• 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.

Quarterly Chart Reviews and Education

• 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.

Coding Tools, Workflow Support, and Operations

• 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.

IPA Coding Helpdesk Support

• 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.

HCC Outage and Recapture Support

• 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.

Required Qualifications

• 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 (Orange City, FL 32763)

Preferred Qualifications

• 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.

Additional Information

• We ask that you have the ability to travel locally for in‑office provider support.
• Standard working hours required, based on market needs.
• Travel may be required based on provider engagement and business needs.

Work Information

• Workstyle: Hybrid/remote
• Location: Must reside within 50 miles of Orange City, FL 32763
• Hours: Monday–Friday, 8:00 AM–5:00 PM; additional time may be required.

TB Statement

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Driving Statement

This role is part of our company's driver safety program and therefore requires an individual to have a valid state driver's license and to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state's minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 for property damage or whichever is higher.

Work at Home Statement

To ensure Home or Hybrid Home/Office Employees' Ability To Work Effectively, the self‑provided internet service must meet the following criteria: at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from home in California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Scheduled Weekly Hours

40

Pay Range

$59,300 – $80,900 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 include medical, dental, and vision benefits, a 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.

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.