IPA Consultative Coder

About the role

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.

Responsibilities

• Support accuracy, compliance, and performance in risk adjustment and value-based care initiatives.
• 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.
• 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.
• 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.
• 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.
• Maintain a high level of responsiveness and provider engagement during the daily coder helpdesk (virtual/Zoom-based).
• Support HCC outage management through structured reviews of “assessed but not coded” conditions.
• Collaborate with analytics and leadership teams to track and improve performance outcomes.

Requirements

• 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
• Reside and be able to travel within the assigned MSO market or region

Preferred Qualifications

• Strong communication and interpersonal skills
• Positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and Education, PCO, and Humana teams

Benefits

Humana offers competitive benefits that support whole-person well-being, including 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.

Work Information

• Standard working hours required; based on market needs.
• Travel may be required based on provider engagement and business needs.
• 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.

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.
• This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program.
• 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.
• 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