Senior Payment Integrity Coder - Remote

Humana Inc; United States; Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Payment Integrity Professional 2 for a remote, work-at-home role. The candidate will use coding knowledge to review claims, identify edit opportunities, and collaborate with internal teams and external vendors to ensure accurate payments the first time.

Strong CMS/Medicaid guidelines mastery is essential. POSITION involves in-depth research, cross-department coordination, and independent decision-making with occasional travel for training or meetings.

Qualifications

• Certified Professional Coder with AHIMA or AAPC certification.
• Minimum of 2 years of experience utilizing coding guidelines, submitting, reading and/or interpreting claims.
• Distinguished knowledge of CPT, HCPCS and ICD code sets.
• Exceptional understanding of CMS guidelines, state Medicaid guidelines, correct-coding initiatives, benchmarks and industry standards.
• Comfortable presenting to a large audience.
• Analytical thinking and strong attention to detail.
• Can work independently and determine appropriate courses of action.
• Familiarity with Humana Code Editing Processes (preferred).

Responsibilities

• Research and apply code editing guidelines to ensure correct claim payment.
• Collaborate across departments and with external code-edit vendors as needed.
• Independently determine the appropriate course of action in ambiguous situations.
• Identify and validate new code edit opportunities to improve claims processing.

Skills

Certified Professional Coder

Coding guidelines

CMS guidelines

Analytical thinking

Attention to detail

Independent decision making

Public speaking

Code editing tools

Tools

Code editing tools

Job description

Humana Inc. is seeking a Payment Integrity Professional 2 for a remote, work-at-home role. The candidate will use coding knowledge to review claims, identify edit opportunities, and collaborate with internal teams and external vendors to ensure accurate payments the first time.

Strong CMS/Medicaid guidelines mastery is essential. POSITION involves in-depth research, cross-department coordination, and independent decision-making with occasional travel for training or meetings.