Humana Inc. is hiring a Payment Integrity Coding Professional for its Code Edit Vendor Management (CEVM) team. In this role, you will contribute to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim payment. You'll conduct in-depth research, collaborate across departments, and independently determine appropriate courses of action on moderately complex to complex issues.
What You'll Do
- Monitor and analyze Code Edit operational processes and performance metrics to identify inefficiencies and opportunities for improvement.
- Partner with internal business partners to support business initiatives, including identifying root causes of challenges, designing solutions, and implementing them.
- Build and maintain strong internal working relationships at all levels of the organization and across the Enterprise to drive innovation and effective operations.
- Engage in implementations and/or ad hoc projects within assigned scope to understand requirements, support and guide team members on priorities, and help manage risks and escalations.
What We're Looking For
- AAPC or AHIMA Coding Certification
- 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
- Ability to work independently and determine appropriate courses of action
- Capacity to handle multiple priorities
- Ability to maintain confidentiality
- Excellent communication skills both written and verbal
- Passion for contributing to an organization focused on continuously improving consumer experiences
Nice to Have
- 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
Technical Stack
- CAS
- Code Edit vendor tools
Benefits & Compensation
- Compensation: $65,000 - $88,600 per year
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
Work Mode
This is a remote position open to candidates located anywhere in the United States.
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.
