[Hiring] Consultative Coding Professional @CenterWell

Role Description

The Consultative Coder provides medical coding expertise to support clinical staff (Physicians and Advanced Practice Providers) to ensure the documentation within medical records supports diagnostic and procedural coding.

• Relationship/Concierge Services:
  • Build strong relationships with physicians and advanced practice providers, serving as their primary point of contact for documentation- and coding-related questions and concerns.
• Documentation Improvement and Education:
  • Identify opportunities to improve documentation through one-on-one engagement with clinicians.
  • Partner with the clinical and coding education teams to deliver targeted training.
  • Analyze trends, triage, and answer questions in real-time.
  • Research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues.
• Post-Visit/Offshore Coding Collaboration:
  • Perform Quality Assurance on post-visit reviews.
  • Review the encounter for potential missed opportunities.
  • Address nonbillable services at the provider level.
  • Address documentation deficiencies resulting in non-billable services in a timely manner.
  • Serve as liaison to provide timely updates on documentation requirements and process changes.
• Mergers and Acquisitions:
  • Conduct PCO Process training including reporting for open notes and addendums, and gap attestation process and performance expectations.
  • Train acquired providers on PCO documentation requirements and processes.
  • Summarize and analyze AWV completion rates.
  • Collaborate with HEDIS leaders and champions to identify HEDIS gaps and deficiencies.
  • Participate in Payer calls/chart reviews.
  • Compile payer findings and assist with research.
  • Participate in payor meetings/discussions to ensure accurate data submission.
• Work Environment:
  • This position requires both local and overnight travel dependent upon business needs.

Qualifications

• 3 or more years of technical Medical Coding experience or similar (including IPA and Offshore coding management).
• RHIA, RHIT, CCS, or CPC Certification.
• Ability to travel both locally and overnight.

Requirements

• Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
• Ability to communicate effectively and sensitively with clinicians and team members in stressful situations.
• Possess strong business acumen, excellent strategic thinking, and effective critical thinking skills.
• Excellent verbal and written communications skills with demonstrated ability to communicate, present, and influence both credibly and effectively at all levels of an organization.
• Ability to work in a rapidly changing, matrixed environment.
• Has a positive, collaborative mindset to foster partnership within the Coding, Audit, and Education department, the PCO, and Humana.

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.