IPA Consultative Coder - Palm Beach (Boca Raton / South County)

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. 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.

Location: Palm Beach Gardens, FL 33410

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.

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 (Palm Beach Gardens, FL 33410)

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.

Pay

$59,300 - $80,900 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Schedule

Monday–Friday, 8:00 AM–5:00 PM; additional time may be required. Standard working hours required; based on market 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. Must reside within 50 miles of Palm Beach Gardens, FL 33410.

Travel may be required based on provider engagement and business needs. Valid state driver's license and personal vehicle liability insurance required (minimum $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 for property damage or higher).

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 Requirements

Self-provided internet service must meet at minimum a download speed of 25 Mbps and an upload speed of 10 Mbps; 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 telephone equipment appropriate to meet business requirements. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected, you will be required to be screened for TB.