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Hampton, Virginia, United States
Hybrid
Relationship Management and Provider Support
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.
Quarterly Chart Reviews and Education
Conduct quarterly chart reviews for assigned providers to evaluate coding accuracy, documentation integrity, and risk capture opportunities.
Develop and deliver comprehensive education based on findings, including documentation best practices and coding optimization strategies.
Identify trends and recurring gaps, and partner with education and leadership teams to address systemic opportunities.
Coding Tools, Workflow Support, and Operations
Support daily operations of internal coding solutions, including Annual Proof of Documentation (APD 2.0) and any future tools implemented based on organizational needs.
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.
IPA Coding Helpdesk Support
Participate in a daily coder helpdesk (virtual/Zoom-based), providing real-time support to providers within assigned markets.
Address immediate coding and documentation questions, ensuring accurate guidance.
Maintain a high level of responsiveness and provider engagement.
HCC Outage and Recapture Support
Support HCC outage management through structured reviews of “assessed but not coded” conditions.
Conduct targeted reviews to identify missed coding opportunities and provide education to improve recapture performance.
Collaborate with analytics and leadership teams to track and improve performance outcomes.
Required Qualifications:
3+ years of risk adjustment Medical Coding or risk adjustment Provider Education
Intermediate/advanced competency with MS Office based programs (Excel, Word, PowerPoint)
Must be certified at least one of the following: CCS, CRC, or CPC
Must reside and be able to travel within the assigned MSO market or region.
Preferred Qualifications:
Strong communication and interpersonal skills are essential. These skills enable effective, clear, and sensitive engagement with clinicians and team members, even in high-pressure or stressful situations. They also facilitate presenting, influencing, and building credibility at all levels of the organization.
Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and Education, PCO, and Humana teams.
Additional Information
We ask that you have the ability to travel locally for in-office provider support.
Standard working hours required; based on market needs.
Travel may be required based on provider engagement and business needs.
Work Information:
This role requires an in-center presence, involving daily commute to assigned clinic(s) and occasional (quarterly) travel within the market to alternative clinic(s) for strategic meetings.
Workstyle: Hybrid/remote
Location: Must reside within 50 miles from Newport News, Hampton or Williamsburg, Virginia.
Hours: Monday–Friday, 8:00 AM–5:00 PM; additional time may be required.
TB Statement:
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Driving Statement:
This role is part of our company's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
Work at Home Statement
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Scheduled Weekly Hours
40Pay 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 pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.