Remote Payment Integrity Coder (Medicare/Medicaid)

Humana Inc; Boise (ID); On-site; USD 65,000 - 89,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) plan

Paid time off

Company holidays

Parental & caregiver leave

Disability insurance

Life insurance

Job summary

Humana Inc. is seeking a Payment Integrity Professional 2 to enhance cost reduction through expert code edits and CMS/Medicaid guideline adherence.

The role requires independent decision-making, research, and collaboration with internal teams and external vendors, with remote work and periodic travel for training. Responsibilities include validating edits, presenting findings, and driving improvements while following coding guidelines.

Qualifications

• Certified Professional Coder with AHIMA or AAPC certification.
• Minimum of 2 years of experience utilizing coding guidelines.
• Distinguished knowledge of CPT, HCPCS and ICD code sets.
• Exceptional understanding of CMS guidelines and Medicaid rules.
• Comfortable presenting to a large audience.
• Analytical thinking and attention to detail.
• Can work independently and determine appropriate actions.
• Comfortable presenting to a large audience.

Responsibilities

• Edit codes to ensure correct claim payments.
• Identify and validate new code edit opportunities promptly.
• Collaborate with internal stakeholders and external vendors.
• Drive process improvements and ensure smooth operations.
• Follow established coding guidelines and procedures.

Skills

Coder certification

CPT/HCPCS/ICD

CMS guidelines

Public speaking

Analytical thinking

Attention to detail

Independent worker

Vendor tools familiarity

Tools

Code editing tools

Microsoft Office

Humana systems

Job description

Humana Inc. is seeking a Payment Integrity Professional 2 to enhance cost reduction through expert code edits and CMS/Medicaid guideline adherence.

The role requires independent decision-making, research, and collaboration with internal teams and external vendors, with remote work and periodic travel for training. Responsibilities include validating edits, presenting findings, and driving improvements while following coding guidelines.