• The Outpatient Coder is responsible for accurately abstracting data into appropriate client electronic medical record systems • Performs data entry of required abstracted patient information into the client’s information system • Maintains consistent coding accuracy rate of 95% or better while also meeting productivity standards • Assigns appropriate ICD-10-CM, CPT, HCPCS codes and modifiers to facility-based Ancillary, Emergency Department, Observation, and/or Outpatient Surgery Accounts as per designated workflow • Queries physicians to clarify conflicting, imprecise, incomplete, ambiguous, and/or inconsistent clinical information when appropriate

• Review operative reports and clinical documentation to assign appropriate CPT, ICD-10-CM, and HCPCS Level II codes. • Ensure accurate capture of modifiers and adherence to payer-specific coding guidelines. • Verify that all coded information supports medical necessity and aligns with regulatory requirements (e.g., CMS, AMA, and payer-specific policies). • Query physicians for clarification or additional documentation when necessary. • Maintain current knowledge of coding guidelines, compliance requirements, and regulatory updates. • Collaborate with billing, compliance, and revenue cycle teams to resolve coding and claim issues. • Participate in internal audits and quality assurance reviews. • Meet productivity and accuracy benchmarks as established by the department. • Protect patient confidentiality in accordance with HIPAA standards.

Role Description Elle/il assure la coordination de l’activité médicale et paramédicale du CMS. Elle/il garantit la qualité, la continuité et la sécurité des soins, organise la coordination des pratiques médicales et paramédicales et contribue aux actions de prévention et de santé publique, en lien avec la direction du pôle. Elle/il exerce un rôle de référent.e sur la dimension médicale du fonctionnement du CMS, en complémentarité avec l’organisation administrative et financière de la structure. - Coordonner l’activité médicale et paramédicale du Centre Municipal de Santé - Veiller à la continuité, à la qualité et à la sécurité des soins - Participer à l’organisation de l’activité des médecins, en lien avec le Responsable administratif et financier - Harmoniser les pratiques médicales et veiller à la bonne application des protocoles - Assurer une veille sanitaire, épidémiologique et réglementaire dans son champ de compétence - Participer à l’accueil, à l’intégration et au suivi des nouveaux praticiens et des stagiaires du domaine médical - Identifier les besoins d’évolution des pratiques et de formation des professionnels médicaux - Contribuer au bon usage du logiciel métier et des outils informatiques liés à l’activité médicale - Participer à l’élaboration et à la mise en œuvre du projet de santé du CMS - Développer et suivre les actions de prévention, d’éducation à la santé et de santé publique - Participer aux réponses aux appels à projets relevant du champ médical et préventif - Contribuer aux relations avec les partenaires institutionnels et professionnels de santé - Participer aux projets transversaux du CMS, du pôle et de la collectivité - Assurer des consultations de médecine générale avec ou sans rendez vous - Participer aux actions de prévention en lien avec le Contrat Local de Santé Qualifications - Maîtrise du système de santé et des enjeux de santé publique - Maîtrise de la réglementation sanitaire et médico-sociale - Connaissance de l’environnement institutionnel des collectivités territoriales - Compétences managériales - Capacité à analyser l’activité et à proposer des ajustements organisationnels - Maîtrise des outils bureautiques et des logiciels métiers - Maîtrise des enjeux de prévention et d’accès aux soins - Maîtrise de l’organisation et du contrôle de l’activité des équipes - Connaissance des règles de prévention des risques professionnels - Connaissance des bases de la gestion administrative et budgétaire de la fonction publique territoriale

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.