Remote Medicare Coding & Claims Integrity Specialist

Humana Inc; Montpelier (VT); On-site; USD 65,000 - 89,000; Full time

Benefits offered by this job

Health benefits

401(k) retirement plan

Paid time off

Job summary

Humana Inc. is seeking a Payment Integrity Professional 2 for a remote, work-at-home role. You will use coding knowledge to guide edits and ensure correct claim payments, requiring deep knowledge of CPT, HCPCS, ICD, CMS, and Medicaid guidelines.

Expect collaboration across departments and with external vendors, with opportunities to drive process improvements. Qualifications include a CPC certification (AHIMA or AAPC), 2+ years with coding guidelines, and strong presentation, analytical, and

Qualifications

• Certified Professional Coder with AHIMA or AAPC
• Minimum of 2 years experience using coding guidelines, submitting, reading and/or interpreting claims
• Knowledge of CPT®, HCPCS and ICD code sets
• Strong CMS and state Medicaid guidelines knowledge
• Comfortable presenting to a large audience
• Analytical thinking
• Strong attention to detail
• Ability to work independently and determine actions

Responsibilities

• Identify and validate new code edit opportunities to ensure correct claim payments
• Research coding guidelines and CMS/Medicaid rules
• Collaborate with cross-department teams and external code editing vendors
• Foster relationships with Code Edit Management and stakeholders
• Drive process improvements and ensure smooth business operations

Skills

CPC certification

Coding guidelines

CMS guidelines

Public speaking

Analytical thinking

Attention to detail

Independent work

Tools

Code editing tools

Microsoft Office

Job description

Humana Inc. is seeking a Payment Integrity Professional 2 for a remote, work-at-home role. You will use coding knowledge to guide edits and ensure correct claim payments, requiring deep knowledge of CPT, HCPCS, ICD, CMS, and Medicaid guidelines.

Expect collaboration across departments and with external vendors, with opportunities to drive process improvements. Qualifications include a CPC certification (AHIMA or AAPC), 2+ years with coding guidelines, and strong presentation, analytical, and