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

• Provide medical coding expertise and consultative support to IPA affiliates.
• Analyze trends, triage, and answer questions in real-time regarding coding and documentation.
• 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.
• Collaborate with STARS leaders and champions to identify STARS gaps and deficiencies.
• Support IPA-affiliated clinicians to ensure documentation supports accurate diagnostic coding and risk adjustment capture.
• Build consultative relationships with providers to support continuous improvement in coding accuracy and documentation practices.
• 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.
• 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.
• 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.

Qualifications

• 3+ years of risk adjustment Medical Coding or risk adjustment experience.
• 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: 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.