Clinical Support Team Senior Consultation/Partnership

Company: Humana
Location: Birmingham
Posted on: November 26, 2022

Job Description:

DescriptionThe Senior Market Consultation/Partnership Professional promotes and improves the quality and measurement of care delivery programs with a market(s). The Senior Market Consultation/Partnership Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.ResponsibilitiesBe part of our Clinical Support Team - Humana is seeking a Clinical Consultant who will be accountable for developing and maintaining key relationships and work with assigned area to optimize business results.Humana is seeking a Clinical Consultant - Certified Medical Coder to join the Clinical Support Team within the Healthcare Quality Reporting & Improvement department. Duties will include:

• Help ensure accurate review of medical records for Medicare and Commercial Risk Adjustment purposes
• Review and respond to appeals to determine the final outcome when discrepancies in coding interpretation are identified
• Provide support for establishment and monitoring of Humana's medical coding communication efforts to promote accurate and complete documentation
• Recommend and review medical coding related education for medical record documentation guidelines
• Review and respond to results from medical record audits as necessary
• Develop and maintain coding guidelines and policies related to diagnosis coding to ensure compliance with ICD-10-CM guidelines and industry standards and educate associates on these guidelines and policies
• Keep current on all governmental medical and legal issues specific to coding and compliance
• Research and respond to coding inquiries from Humana coders
• Support and participate in process and quality improvement initiatives.
• Interact with and support a multidisciplinary clinical outcomes team involved in ensuring that HQRI initiatives result in the highest quality of member care.
• Work collaboratively with business partners to ensure a strong understanding of coding and documentation amongst Humana's coders.Role Essentials
  • Nursing degree or clinical degree
  • Certified Medical Coder with one of the following active certifications and with a high degree of competency:
  • CPC - Certified Professional Coder (AAPC)
  • COC - Certified Outpatient Coder (AAPC)
  • CIC - Certified Inpatient Coder (AAPC)
  • CRC - Certified Risk Adjustment Coder (AAPC)
  • CCA - Certified Coding Associate (AHIMA)
  • CCS - Certified Coding Specialist (AHIMA)
  • CCS-P - Certified Coding Specialist - Physician based (AHIMA)
  • Proficient with use of ICD-10-CM Coding Manual
  • Experience in completing efficient health-related research, with associated analysis and conclusions
  • Working knowledge of HEDIS, Stars, and other clinical quality measures
  • Basic PC skills (including Microsoft Office - Word, PowerPoint and Excel) required.
  • Experience with technical writing
  • Excellent communication skills, both written and verbal plus effective listening
  • Strong organizational skills
  • Interpersonal skills
  • Self-management, responsibility and accountability
  • Attention to detail
  • Strong analytical skillsRole Desirables
    • Working knowledge or experience with Medicare and/or Commercial risk adjustment
    • Prior experience in a role/s within a medical office or facility environment
    • Experience with medical records, both paper and electronic for reviewing records
    • Experience with American Hospital Association Coding Clinic, Official Guidelines for Coding and Reporting, and CMS risk adjustment regulationsReporting Relationships
      • This area is under the leadership of the Assistant Vice President of Risk Adjustment Compliance within the Healthcare Quality Reporting & Improvement departmentScheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Keywords: Humana, Birmingham , Clinical Support Team Senior Consultation/Partnership, Healthcare , Birmingham, Alabama