IPA Consultative Coder

About the role

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.

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.
• Provide 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.
• 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.
• 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.
• 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 a daily coder helpdesk (virtual/Zoom-based).
• Support HCC outage management through structured reviews of “assessed but not coded” conditions, conducting targeted reviews to identify missed coding opportunities and providing education to improve recapture performance.
• Collaborate with analytics and leadership teams to track and improve performance outcomes.

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.
• A positive, collaborative mindset with an ability to foster partnerships across Coding, Audit and Education, PCO, and Humana teams.

Additional Information

• 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 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.

Work Information

• 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.
• Workstyle: Hybrid/remote.

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.

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.

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.