Become a part of our caring community
The Senior Market Consultation / Partnership Professional (Nurse Medical Coder) supports Clinical Support Team (CST) initiatives by promoting accurate, compliant, and complete documentation and coding practices that enhance the quality and measurement of programs across risk adjustment. Work assignments involve moderately complex to complex issues where analysis of clinical documentation, coding accuracy, and risk adjustment data requires evaluation of multiple variable factors.
Key Responsibilities
- Perform detailed medical record reviews to ensure accurate ICD-10-CM coding, risk adjustment capture, and alignment with CMS-HCC (e.g., V24/V28) models
- Validate diagnosis coding and ensure documentation meets compliance standards
- Identify and escalate coding trends and documentation gaps
- Serve as a coding subject matter expert supporting CST workflows, including PDV, chart review prioritization, and provider outreach
- Partner with clinical and operational teams to drive coding accuracy
- Engage and partner with physicians, physician groups, and market leadership to improve documentation and coding practices
- Deliver targeted coder education focused on compliance, coding specificity and accuracy
- Analyze coding trends, audit findings, and performance metrics to identify opportunities for improvement
- Develop actionable insights and recommendations to improve coding accuracy
- Support continuous quality improvement processes across CST and stakeholders
- Exercise judgment in selecting methodologies and approaches to meet program objectives
Use your skills to make an impact
Required Qualifications
- Active RN license (BSN preferred) or equivalent clinical licensure
- Certified Professional Coder (CPC), CRC, CCS
- Strong knowledge of ICD-10-CM coding guidelines, risk adjustment methodologies, and documentation standards
- Experience with medical record review, coding validation, and audit processes
- Proficiency in analyzing and interpreting data trends and applying continuous quality improvement processes
- Excellent written and verbal communication skills
- Strong proficiency in Microsoft Office tools (Word, Excel, Access)
- Demonstrated ability to work independently and manage multiple priorities
Preferred Qualifications
- Experience in Medicare Advantage risk adjustment (CMS-HCC models)
- Background in provider education, clinical documentation improvement (CDI), or market-based consulting
- Experience working in a matrixed environment supporting cross-functional teams
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 07-05-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
