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Humana Clinical Documentation Specialist in Lancaster, South Carolina


Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Family Physicians Group (FPG) and Partners in Primary Care (PIPC), we want to help people everywhere, including our associates, lead their best lives. At FPG, we're seeking innovative people who want to make positive changes in their lives, the lives of our patients, and the healthcare industry as a whole.

As a senior-focused healthcare provider, and subsidiary of one the nation's leading integrated health companies, Humana, we put the needs of seniors at the forefront of everything we do. Our multidisciplinary team goes above and beyond to make our centers a leading health and wellness destination for communities in key Medicare markets. Partners in Primary Care and FPG's national primary care centers serve more than 30,000 Medicare Advantage patients in markets including Kansas City, North Carolina, South Carolina, Orlando, Las Vegas, Louisiana and Houston.

Work at home; may require 25-50% in office time as needed within market. Prefer Orlando, FL location. Can work in: Houston, TX; Kansas City, KS; Kansas City, MO; Charlotte, NC; Greenville, SC; Las Vegas NV or Shreveport, LA. Must live in market.


The Clinical Documentation Specialist (CDS) follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. The Clinical Documentation Specialist conducts medication reviews of charts to compare prescribed medications against clinical diagnoses. The Clinical Documentation Specialist communicates with providers and staff to clarify diagnoses and/or information, and will collaborate and educate current staff providers around clinical insights derived from patient medical records.

The Clinical Documentation Specialist (CDS) conducts prospective, concurrent and retrospective clinical chart reviews of patient medical records for Humana's Care Delivery Organization (CDO). The CDS associate works to assess medical documentation with the intent of identifying and compiling potential diagnoses which inform a clinically-backed focus of care for providers. The CDS works with providers to ensure clinical documentation accurately reflects severity of illness in compliance with government and other regulations for all patients. The Clinical Documentation Specialist ensures coding is accurate and properly supported by clinical documentation within the health record and enters all necessary information into the system.

Clinical Documentation Specialists facilitate clinical documentation that accurately depicts the level of clinical services and patient severity of illness. The CDO CDS identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The CDS reviews medical records and arranges educational sessions with providers aimed at quality of care and documentation improvements. CDS associates provide recommendations to ensure complete documentation for data reporting purposes and communicate results of education to leaders. This role requires extensive interaction with physicians and other caregivers as well as medical records coding teams. The successful candidate will possess strong communications skills; the ability to develop collaborative professional relationships; and time management.

Clinical Documentation Specialists perform CDS record reviews, query providers through approved CDO processes, and assign ICD10 and CPT codes to medical record encounters. This role requires a focus on detail and accountability, and the ability interpret and apply coding guidelines. The Clinical Documentation Specialist will perform work that meets CDO production and quality standards. As directed by leadership, CDS associates participate in process improvement activities based on audit results and organizational performance improvement projects impacted by documentation. CDS associates will participate in instruction relating to new technology and technology updates or continuing education.

The Clinical Documentation Specialist understands own work area, professional concepts/standards, regulations, strategies and operating standards. The CDS makes decisions regarding his or her own work approach/priorities, and follows direction. CDS work is managed and often guided by documented procedures/regulations/professional standards with some interpretation. The Clinical Documentation Specialist work assignments are often straightforward and of moderate complexity.

Required Qualifications

  • AAPC CPC (Certified Professional Coder) Certification or CRC (Certified Risk Coder) within 1 year of employment

  • 2 years clinical practice experience, international experience acceptable

  • Fluent in English - speaking and writing

  • Strong knowledge of Microsoft Office products (Outlook, Word, Excel, Teams)

  • Strong written and verbal communication skills; strong analytical, organizational and time management skills

  • Ability to build and maintain effective relationships with internal stakeholders

  • Demonstrated strong interpersonal communication including a willingness to consistently provide superior customer service and the ability to react with a professional demeanor

  • This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Advanced clinical degree strongly preferred, foreign medical credentials acceptable

  • Electronic medical record experience, eCW highly preferred

  • Experience in a fast paced, metric driven operational setting

  • 4 years' experience coding in a value based care medical office environment

  • In-depth knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.

  • Understanding of the application of authoritative guidance to the interpretation and analysis of documentation, coding, and queries.

  • Bachelor's Degree

Work at home; may require 25-50% in office time as needed within market. Prefer Orlando, FL location. Can work in: Houston, TX; Kansas City, KS; Kansas City, MO; Charlotte, NC; Greenville, SC; Las Vegas NV or Shreveport, LA. Must live in market.

Scheduled Weekly Hours