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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.
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.
$78,400 - $107,800 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 07-17-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
