[Hiring] Senior Coding Educator @Humana

Role Description

The Senior Coding Educator will work closely with providers to identify documentation and coding improvement opportunities and give guidance around operational and clinical best practices in the risk adjustment methodology.

• This role reports to the Risk Adjustment Manager and will work closely with market operations, finance, and clinical teams.
• The successful candidate will possess extensive knowledge of the HCC risk adjustment methodology gained from experience in chronic condition documentation and coding audits, risk adjustment program implementation, and provider education delivery.
• Ability to analyze provider performance metrics to identify risk adjustment gaps and develop action plans.
• Commitment to cultivating internal and external business relationships to achieve desired outcomes.
• Develop a comprehensive understanding of Humana’s risk adjustment programs and resources for successful implementation.
• Perform analysis of performance indicators and create formal presentations for reporting to providers.
• Provide measurable, actionable solutions to improve accuracy of documentation and coding.
• Assist providers in understanding the CMS - HCC Risk Adjustment program and the importance of proper chart documentation.
• Knowledge of EMR interoperability solutions to influence provider groups in population health management.
• Facilitate presentations and train physicians and staff regarding documentation, billing, and ICD10 coding.
• Cultivate effective partnerships in a matrix environment of coding educators, medical directors, and clinical operations.
• Facilitate, track, and trend reporting to leadership and participating groups, making recommendations for improvement.

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, including online delivery.
• Advanced Microsoft Office skills including Word, Excel, Outlook, and PowerPoint.
• Advanced knowledge of billing/claims submission and related functions.
• Demonstrated ability to manage competing priorities and projects simultaneously.
• Demonstrated ability to adapt quickly to change.

Requirements

• Bachelor’s Degree (preferred).
• Certified Risk Adjustment Coder (CRC) (preferred).
• Certified Documentation Expert Outpatient (CDEO) (preferred).
• Knowledge of EMR (Athena, Epic, and eCW) (preferred).
• Experience in risk adjustment field in physician practice or provider group (preferred).
• Review reports and analyze data to identify areas of improvement opportunities for provider groups (preferred).

Benefits

• Medical, dental, and vision benefits.
• 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.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health.