Remote Payment Integrity Specialist (CPT/ICD Expert)

Humana Inc; Helena (MT); On-site; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is seeking a remote Payment Integrity Professional 2 who will leverage coding expertise to optimize claim payments and reduce costs.

The role requires independent decision-making, cross-department collaboration, and adherence to coding guidelines to ensure accurate processing on the first pass. Responsibilities include identifying new code edit opportunities, guiding internal teams and external vendors, and driving process improvements while following established procedures.

Qualifications

• Certified Professional Coder with AHIMA or AAPC certification.
• Strong knowledge of CPT, HCPCS and ICD code sets.
• Familiarity with CMS guidelines and national coding initiatives.

Responsibilities

• Identify and validate code edit opportunities to ensure correct claim payments.
• Collaborate with internal stakeholders and external vendors to improve processes.
• Research and determine appropriate actions in ambiguous situations with minimal direction.

Skills

Certified Professional Coder

CMS guidelines

Analytical thinking

Attention to detail

Independent worker

Public speaking

Tools

Code editing tools

Job description

Humana Inc. is seeking a remote Payment Integrity Professional 2 who will leverage coding expertise to optimize claim payments and reduce costs.

The role requires independent decision-making, cross-department collaboration, and adherence to coding guidelines to ensure accurate processing on the first pass. Responsibilities include identifying new code edit opportunities, guiding internal teams and external vendors, and driving process improvements while following established procedures.