[Remote] Senior Coding Educator at Humana

Washington, District of Columbia, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

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

Responsibilities

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
Develop a comprehensive understanding of Humana’s risk adjustment programs and the resources required for successful implementation
Develop and apply keen insight of our providers and our KPIs, and be able to strategically assess where improvements can be made in the most effective way with available resources
Perform analysis of performance indicators and put together a formal presentation for reporting out to providers on a regularly scheduled basis
Provide measurable, actionable solutions to providers that will result in improved accuracy of documentation and coding, and adoption of best practices
Successfully implement identified course of action to effectively impact risk adjustment deadlines and report on progress regularly
Assist providers in understanding the CMS - HCC Risk Adjustment program as a payment methodology and the importance of proper chart documentation
Facilitate presentations and train physicians and other staff regarding documentation, billing and ICD10 coding, and provide feedback to physicians regarding documentation practices and compliance with state and federal regulations
Cultivate effective partnerships in a matrix environment of coding educators, medical director, clinical and market operations
Facilitate, track and trend for reporting to leadership and participating groups and be able to make recommendations for improvement

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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