Remote Medicare/Medicaid Coding Specialist

Humana Inc; Juneau (AK); On-site; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is seeking a Payment Integrity Professional 2 to contribute to cost reduction by applying coding guidelines and identifying data anomalies to ensure correct claim payments.

This remote, work-at-home role emphasizes expert CPT/HCPCS/ICD knowledge, CMS and Medicaid guidelines, and the ability to collaborate across departments and with external vendors. The ideal candidate will thrive with minimal direction, drive process improvements, and maintain compliance with HIPAA and industry

Qualifications

• Certified Professional Coder with AHIMA or AAPC certification.
• Minimum of 2 years of experience utilizing coding guidelines, submitting, reading and/or interpreting claims.
• Strong knowledge of CPT, HCPCS and ICD code sets.
• Extensive CMS guidelines and Medicaid guideline familiarity; national benchmarks and industry standards.

Responsibilities

• Lead in-depth research and determine appropriate actions in ambiguous situations.
• Identify and validate new code edit opportunities to ensure correct claim payments on first pass.
• Foster relationships with Code Edit Management, internal stakeholders, and external vendors; drive process improvements.

Skills

CPT/HCPCS/ICD knowledge

CMS guidelines

Analytical thinking

Independent decision making

Public speaking

Job description

Humana Inc. is seeking a Payment Integrity Professional 2 to contribute to cost reduction by applying coding guidelines and identifying data anomalies to ensure correct claim payments.

This remote, work-at-home role emphasizes expert CPT/HCPCS/ICD knowledge, CMS and Medicaid guidelines, and the ability to collaborate across departments and with external vendors. The ideal candidate will thrive with minimal direction, drive process improvements, and maintain compliance with HIPAA and industry