Senior Coding Educator

Humana; Myrtle Point (OR); Remote; USD 71,000 - 98,000; Full time

Job summary

A healthcare organization is seeking a Senior Coding Educator to enhance provider engagement in risk adjustment methodologies. The role requires extensive experience in coding education, performance improvement, and provider education delivery. Candidates must be proficient in coding audits and have strong analytical skills. This position offers a remote work opportunity along with occasional travel requirements.

Benefits

Competitive salary

Bonus incentive plan

Comprehensive benefits package

Qualifications

• 5+ years of experience in risk adjustment coding/auditing.
• In-depth knowledge of risk adjustment key performance indicators.
• Prior experience engaging with providers in performance improvement programs.

Responsibilities

• Develop a comprehensive understanding of risk adjustment programs.
• Perform analysis of performance indicators and prepare presentations.
• Implement courses of action to improve documentation and coding accuracy.

Skills

Risk adjustment coding/auditing

Provider relations/engagement

Facilitation and presentation skills

Advanced Microsoft Office skills

Ability to manage competing priorities

Education

Certified Professional Coder (CPC)

Bachelor’s Degree

Tools

Microsoft Word

Microsoft Excel

EMR (e.g., Athena, Epic, eCW)

Job description

Overview

Become a part of our caring community and help us put health first. The Senior Coding Educator will work closely with providers to identify documentation and coding improvement opportunities and provide guidance around operational and clinical best practices in the risk adjustment methodology. This role reports to the Risk Adjustment Manager and will collaborate with market operations, finance, and the clinical team to influence providers to adopt best practices in the risk adjustment methodology. The successful candidate will possess extensive, in-depth knowledge of the HCC risk adjustment methodology gained from experience with chronic condition documentation and coding audits, risk adjustment program implementation, and provider education delivery. The ideal candidate will also be able to analyze provider performance metrics, identify where risk adjustment gaps exist, and develop an action plan to close them using available resources. Building internal and external business relationships to achieve desired outcomes is required.

Responsibilities

• Develop a comprehensive understanding of Humana’s risk adjustment programs and the resources required for successful implementation.
• Develop and apply keen insight into our providers and KPIs, and strategically assess where improvements can be made in the most effective way with available resources.
• Perform analysis of performance indicators and prepare formal presentations for reporting to providers on a regular basis.
• Provide measurable, actionable solutions to providers that improve documentation and coding accuracy and adoption of best practices.
• Implement identified courses of action to impact risk adjustment deadlines and report progress regularly.
• Assist providers in understanding the CMS - HCC Risk Adjustment program as a payment methodology and the importance of proper chart documentation.
• Demonstrate knowledge of EMR interoperability solutions to influence provider groups in population health management through Point of Care Alerts and Supplemental Data (e.g., Epic, Athena, and eCW).
• Facilitate presentations and train physicians and other staff on documentation, billing, ICD-10 coding, and provide feedback on documentation practices and regulatory compliance.
• Cultivate effective partnerships in a matrix environment of coding educators, medical director, clinical and market operations.
• Facilitate, track and trend for reporting to leadership and participating groups and make recommendations for improvement.

Required Qualifications

• 5+ years of experience in risk adjustment coding/auditing/education and provider relations/engagement
• Certified Professional Coder (CPC)
• Prior experience in successfully engaging with providers to participate in performance improvement programs
• In-depth knowledge of risk adjustment key performance indicators and CMS payment models (V24 and V28)
• Prior experience working in a cross-functional team
• Expert facilitation and presentation skills to include online delivery
• Advanced Microsoft Office skills including Word, Excel, Outlook and PowerPoint
• Advanced knowledge of billing / claims submission and other related functions
• Demonstrated ability to manage competing priorities and to effectively manage projects simultaneously
• Demonstrated ability to adapt quickly to change

Preferred Qualifications

• Bachelor’s Degree
• Certified Risk Adjustment Coder (CR C)
• Certified Documentation Expert Outpatient (CDEO)
• Knowledge of EMR (Athena, Epic and eCW)
• Experience in risk adjustment within a physician practice or provider group
• Ability to review reports and analyze data to identify improvement opportunities for provider groups

Additional Information

As part of our hiring process for this opportunity, we may use HireVue interviewing technology to enhance hiring and decision-making. HireVue enables us to connect with you and gain valuable information about your skills and experience at a time that works for you.

Work At Home/Internet Information

To ensure home or hybrid home/office employees can work effectively, self-provided internet service must meet the following criteria:

• At minimum, download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable or DSL connection suggested.
• Satellite, cellular, and microwave connections require leadership approval.
• Employees in California, Illinois, Montana, or South Dakota working from home will receive bi-weekly internet expense payments.
• Humana will provide appropriate telephone equipment to meet business requirements.
• Work from a dedicated space with no ongoing interruptions to protect member PHI / HIPAA.

SSN Information

Humana values personal identity protection. Applicants may be asked to provide their Social Security Number if not already on file. When required, an email will be sent from [e-mail] with instructions to add the information on Humana’s secure website.

Travel

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

Scheduling

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 range may vary by geographic location and individual pay based on skills, knowledge, experience, and certifications.

$71,100 - $97,800 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Description of Benefits

Humana offers competitive benefits designed to support whole-person well-being. Benefits include medical, dental and vision, 401(k) retirement savings, paid time off, holidays, volunteer time off, parental and caregiver leave, disability, life insurance, and additional opportunities.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first—for teammates, customers and the company. Through Humana insurance services and CenterWell healthcare services, we aim to help millions achieve their best health and access care when needed.

Equal Opportunity Employer

Humana does not discriminate against applicants or employees based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Humana affirmatively recruits individuals with disabilities and protected veterans in compliance with applicable laws and regulations.