Payment Integrity Coding Professional

Humana

1d • Remote

About The Position

Become a part of our caring community and help us put health first The Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim payment. The Payment Integrity Professional work assignments require in-depth research, cross departmental collaboration, independent determination of the appropriate course of action, and involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Payment Integrity Coding Professional monitors and analyzes Code Edit operational processes and performance metrics to identify inefficiencies and opportunities for improvement. Partners with internal business partners to support business initiatives, including identifying the root cause of challenges, designing solutions to the challenges, and implementing solutions. Builds and maintains strong internal working relationships at all levels of the organization and across the Enterprise; leverages these relationships in helping to drive innovation and effective operations for Humana. Engages in implementations and/or ad hoc projects, within assigned scope of responsibilities to understand requirements, to support and guide team members on priorities and help manage risks and escalations. Use your skills to make an impact WORK STYLE: Remote/Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Standard business hours are Monday - Friday, 8 hours/day, 5 days/week. Core business hours are 8AM - 5PM Eastern time.

Requirements

• AAPC or AHIMA Coding Certification - CPC or CCS
• Minimum 3 years post certification experience utilizing coding guidelines by reading and interpreting claims
• Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct coding initiatives, national benchmarks, and industry standards
• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Strong attention to detail
• Can work independently and determine appropriate courses of action
• Ability to handle multiple priorities
• Capacity to maintain confidentiality
• Excellent communication skills both written and verbal
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates 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 Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Nice To Haves

• Bachelor's degree
• Experience leading people, projects, and/or processes
• Experience using the following systems: CAS and Code Edit vendor tools
• Experience in a fast paced, metric driven operational setting

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level