Risk-Adjustment Coding Consultant (Hybrid/Remote)

CenterWell Senior Primary Care; Virginia Beach (VA); Hybrid; USD 59,300 - 80,900; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana's IPA Consultative Coding Professional will provide medical coding expertise and act as the primary resource for assigned providers to ensure accurate documentation and risk adjustment capture.

The role includes quarterly reviews, targeted education, and coding workflow support across internal tools, with travel within the defined market. Facilities a hybrid/remote work model, with standard hours and quarterly travel as needed.

Qualifications

• 3+ years of risk adjustment medical coding or risk adjustment provider education.
• Intermediate/advanced competency with MS Office (Excel, Word, PowerPoint).
• Certification in CCS, CRC, or CPC.
• Must reside and be able to travel within the assigned MSO market or region.

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 and risk capture opportunities.
• Develop education on documentation best practices and coding optimization strategies.
• Identify trends and partner with leadership to address systemic opportunities.
• Support daily operations of internal coding solutions including APD 2.0 and future tools.
• 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.
• Participate in a daily coder helpdesk providing real‑time guidance to providers within assigned markets.
• Maintain a high level of responsiveness and provider engagement.
• Support HCC outage management through structured reviews and targeted recapture efforts.

Skills

Risk adjustment coding

MS Office

CCS certification

CRC certification

CPC certification

Job description

Humana's IPA Consultative Coding Professional will provide medical coding expertise and act as the primary resource for assigned providers to ensure accurate documentation and risk adjustment capture.

The role includes quarterly reviews, targeted education, and coding workflow support across internal tools, with travel within the defined market. Facilities a hybrid/remote work model, with standard hours and quarterly travel as needed.