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The Senior Market Consultation/Partnership Professional interprets, analyzes, and promotes the use of ICD-10 coding guidelines for the Healthcare Quality Reporting & Improvement organization. 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.

The Senior Market Consultation/Partnership Professional engages and partners with internal risk adjustment coders, business stakeholders, physicians, physician groups, and market leadership to drive initiatives that relate to risk adjustment coding and documentation accuracy. The Clinical Support Team is seeking a senior professional who will be accountable for developing and maintaining key relationships and work with coding and education teams to optimize business results.

Duties will include:

• Help ensure accurate review of medical records for Medicare and Medicaid Risk Adjustment
• Review and respond to appeals to determine the 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 present 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.

Use your skills to make an impact
 

Required Qualifications

• 5 or more years of risk adjustment coding experience
• Strong knowledge of Microsoft Office XP products (Word, Excel, Access)
• Proven ability to communicate effectively in both oral and written formats
• Effective presentation skills
• Demonstrated expertise in data analysis and identifying trends in quality improvement processes
• Extensive business consulting experience

Preferred Qualifications

• Health industry solutions experience
• Bachelor’s degree
• Ability to manage multiple or competing priorities and work in a fast-paced environment with changing priorities
• Intermediate ability to implement process improvements

Additional Information

If you are selected for this position and reside near the Louisville, KY office, you may be required to attend onsite meetings. Additionally, please note that the working hours for this role are based on the Eastern Standard Time Zone.

Work-At-Home Requirements:

• WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.  
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
 
If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment.  You will have a set of questions, and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

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