Independent Practice Association Consultative Coder
Location
Virginia
Posted
8 days ago
Salary
$59.3K - $80.9K / year
Seniority
Senior
No structured requirement data.
Job Description
Independent Practice Association Consultative Coder
Humana
Title: IPA Consultative Coder Locations: Hampton, Virginia Newport News, Virginia Williamsburg, Virginia Hybrid widget:Full time Category:Clinical Support CenterWell Senior Primary Care Job ID:R-420337 Job Description: Become a part of our caring community Become a part of our caring community and help us put health first The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify STARS gaps and deficiencies. The IPA Consultative Coding Professional provides medical coding expertise to support IPA-affiliated clinicians-including physicians and advanced practice providers-to ensure documentation supports accurate diagnostic coding and risk adjustment capture. 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. Use your skills to make an impact 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 40 Pay 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. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. 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. About Us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com. 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.
Related Guides
Related Categories
Related Job Pages
More Medical Billing and Coding Jobs
Lead Coding Specialist Inpatient
Baptist Health South FloridaBaptist Health South Florida, a faith-based, nonprofit healthcare organization, is the largest of its kind in the area and widely known for providing exceptiona
Title: Lead Coding Specialist Inpatient Location: United States Job Description: $5000 Bonus, Fully Remote, CCS or RHIT certified, FT, 8A-4:30P-160275 Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors. What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we're all in. At Baptist Health, we’re committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a “grow our own” philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including: - Career growth and development opportunities, with clear pathways and ongoing support - Comprehensive health and wellness resources that go beyond traditional benefits - A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs - Tuition reimbursement to support continued learning and advancement - And so much more Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day. Description The position will serve as the primary support to the Coding Supervisor. Assist in the supervision of coding, abstracting and reimbursement supporting billing ensuring compliance along with efficient operations for all Baptist Health facilities. Ensures established goals and ICD-10-CM/PCS guidelines, CPT, and coding conventions are adhered to. Assist with monitoring reports and workflows identifying opportunities for improvement, work volume and distribution, reviewing and reconciling reports, providing coding training within the Coding Department and performing research on coding issues. Monitors coding personnel activities ensuring accurate and timely processing in accordance with state and federal regulations. Assist with monitoring reports and workflows identifying opportunities for improvement. Qualifications Degrees: - Associates. Licenses & Certifications: - AHIMA Certified Coding Specialist. Additional Qualifications: - Prefer RHIA or RHIT or equivalent experience. - At least five years Inpatient or Outpatient Surgery, Ancillary and Emergency Room coding experience in a large healthcare institution required. - Excellent verbal and written communication skills with ability to communicate clearly with both internal and external customers, problem-solving and personnel management skills. - Knowledgeable in health information systems, database management, spreadsheet design, and computer technology. - Strong computer proficiency (MS Office – Word, Excel and Outlook). - Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service. - Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices. Minimum Required Experience: 5 Years Job Corporate Primary Location Remote Organization Corporate Schedule Full-time Unposting Date Ongoing EOE, including disability/vets
Title: IPA Consultative Coder Location: Chesapeake United States Chesapeake, Virginia Suffolk, Virginia Virginia Beach, Virginia Job Description: Become a part of our caring community Become a part of our caring community and help us put health first The IPA Consultative Coding Professional provides medical coding expertise and consultative support to Independent Practice Association (IPA) affiliates nationwide. These affiliates include MSO-contracted independent providers. You will be the primary coding and documentation resource for assigned providers, supporting accuracy, compliance, and performance in risk adjustment and value-based care initiatives. You will analyze trends, triage, and answer questions in real-time, as well as research and interpret correct coding guidelines and internal business rules to respond to inquiries and issues. As an IPA Consultative Coding Professional, we will assign you a panel of up to 30 providers within a defined market or region. You will deliver ongoing education, support coding workflows, and ensure agreement on organizational documentation and coding standards, while collaborating with STARS leaders and champions to identify STARS gaps and deficiencies. The IPA Consultative Coding Professional provides medical coding expertise to support IPA-affiliated clinicians-including physicians and advanced practice providers-to ensure documentation supports accurate diagnostic coding and risk adjustment capture. 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. Use your skills to make an impact 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 of Chesapeake, Suffolk or Virginia Beach, 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 40 Pay 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. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. 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. About Us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com. 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.
• Be the point person for questions from your team members. • Coordinate answers with agencies and/or internal departments including Operations. • Sign off/approve credit memos and employee receivables. • Assist with administrative accounting procedures per Controller/CFO. • Audit team performance, monitor team metrics and manage claims process. • Train new employees and existing employees in department procedures and agency requirements. • Assist in developing claims procedures for all new agencies prior to transitioning to Claims Specialist. • Prepare A/R reports for your team’s agencies to monitor unpaid claims. • Work with team members and agencies to collect outstanding payments. • Communicate with Claims Manager including but not limited to: training issues, agency challenges, unbilled items and A/R issues. • Attends trainings, conferences and staff meetings. • Participates in company continuous improvement processes. • Upholds company values and mission • Other duties as assigned
Coding Validation Specialist 3
InovaInova describes itself as the leading nonprofit healthcare provider in northern Virginia. The organization is on a mission to provide world-class healthcare to the people it serves
Role Description Inova Health is looking for a dedicated Coding Validation Specialist 3 to join the team. Full-time Day Shift: Monday–Friday, general office hours, working remotely. - Codes and reviews assigned records with defined productivity standards of four charts per hour for complex/intermediate surgeries and five charts per hour for simple surgeries. - Actively participates in internal pre-bill coding audits, independent coding audits, and coding education sessions. - Enhances professional growth and development by participating in other relevant continuing education activities. - Maintains or surpasses Inova Health System-defined quality standards for accurate assignment and validation of the Evaluation and Management (E/M) assignment of 95 percent. - Ensures correct CPT code for the level of service billed (i.e. Place of Service, Observation codes for Observation Status; Inpatient Codes for Inpatient Status). - Changes consult codes based on Payer requirements to the appropriate E/M code and appropriate units and/or modifiers maintaining an accuracy of 95 percent or greater. - Verifies the accuracy, completeness, and quality of ICD-10-CM, CPT-4, and HCPC coding including modifiers, units, and other variables impacting workload accountability and billing. - Communicates with the responsible physician or mid-level provider accordingly to obtain additional supporting documentation, or clarification required for code assignments and processes, including following an escalation or secondary review as necessary. Qualifications - High School diploma or GED - Three years of coding experience required. - One of the following certifications: RHIT, CCS or CPC, COC or CCS-P. Preferred Qualifications - Strong general surgery coding experience Benefits - Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. - Retirement: Inova matches the first 5% of eligible contributions – starting on your first day. - Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. - Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. - Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Company Description We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.



