Remote Payment Integrity Specialist (Coder)

Visa Hunt; United States; On-site; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

Humana is seeking a Payment Integrity Professional 2 for a remote, work-at-home role. You will use coding guidelines and data analysis to ensure correct claim payments and drive cost reductions. Travel to Humana offices may be required occasionally for training or meetings.

Responsibilities include researching code edits, collaborating with internal teams and vendors, and presenting findings to stakeholders. Strong CPT/HCPCS/ICD knowledge and CMS familiarity are essential.

Qualifications

• Certified Professional Coder with AHIMA or AAPC certification.
• Minimum of 2 years of experience utilizing coding guidelines, submitting, reading and/or interpreting claims.
• Deep knowledge of CPT, HCPCS and ICD code sets.
• Extensive understanding of CMS guidelines, Medicaid guidelines and national benchmarks.
• Willingness to present to large audiences.

Responsibilities

• Identify and validate new code edit opportunities to ensure correct claim payments.
• Research, analyze, and determine appropriate action in collaboration with stakeholders.
• Foster relationships across Code Edit Management and external vendors.
• Drive process improvements to support cost reduction and accuracy.

Education

Certified Professional Coder (AHIMA or AAPC)

2+ years coding experience

CMS guidelines expertise

CPT/HCPCS/ICD knowledge

Strong presentation skills

Tools

Code editing tools

Job description

Humana is seeking a Payment Integrity Professional 2 for a remote, work-at-home role. You will use coding guidelines and data analysis to ensure correct claim payments and drive cost reductions. Travel to Humana offices may be required occasionally for training or meetings.

Responsibilities include researching code edits, collaborating with internal teams and vendors, and presenting findings to stakeholders. Strong CPT/HCPCS/ICD knowledge and CMS familiarity are essential.