The role of the Clinical Innovations Analyst is to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories.
Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.
Review medical record information to identify all appropriate coding based on CMS HCC categories.
Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
Support and participate in process and quality improvement initiatives.
Builds Trust: You honor your word by doing what you say you are going to do.
Drives for excellence: You are a continuous learner who encourages others to learn. By constantly upgrading your own work, you achieve results and outperform the competition.
Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
Certified Medical Coder with high degree of competence in this area
Prior coding experience, preferably in a medical office environment
Strong knowledge of Microsoft Office XP products (Word, Excel, Access)
High school diploma or equivalent required
Extensive travel outside of the office is required and a valid drivers license is required,
Must have reliable transportation.
Knowledge and experience in health care environment/managed care
Professional demeanor and appearance, strong work ethic, reliable, resourceful, enthusiastic, team player with positive attitude
Strong written and verbal communication skills; strong analytical, organizational and time management skills required
You will report to a Clinical Supervisor or Manager. This area is under the leadership of the SVP & Chief Operations Officer.
Clinical Innovations and Health Practitioners
Work Environment Type
Yes, 10 % of the Time
Humana Inc. (Humana) is a full-service benefits solutions company, offering an array of health and supplemental benefit plans for employer...