Risk-Adjustment Coding Advisor (Hybrid/Remote)

Humana Inc; West Palm Beach (FL); Hybrid; USD 59,300 - 80,900; Full time

Job summary

Humana Inc. seeks an IPA Consultative Coding Professional to provide medical coding expertise and consultative support to IPA affiliates nationwide, including MSO-contracted providers.

You will be the primary coding and documentation resource, ensure accuracy and compliance in risk adjustment, and educate providers through targeted insights. The role includes managing a panel of up to 30 providers, delivering education based on trends, and collaborating with STARS leaders to improve coding

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.

Responsibilities

• 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.
• Conduct quarterly chart reviews for assigned providers to evaluate coding accuracy, documentation integrity, and risk capture opportunities.
• Identify trends and recurring gaps, and partner with education and leadership teams to address systemic opportunities.
• Support daily operations of internal coding solutions (APD 2.0) and assist providers in navigating coding workflows.
• Participate in a daily coder helpdesk, providing real-time guidance.
• Support HCC outage management and recapture opportunities.

Skills

Risk adjustment medical coding

MS Office proficiency

CCS CRC or CPC certification

Tools

APD 2.0

Job description

Humana Inc. seeks an IPA Consultative Coding Professional to provide medical coding expertise and consultative support to IPA affiliates nationwide, including MSO-contracted providers.

You will be the primary coding and documentation resource, ensure accuracy and compliance in risk adjustment, and educate providers through targeted insights. The role includes managing a panel of up to 30 providers, delivering education based on trends, and collaborating with STARS leaders to improve coding