[Remote] Code Edit Disputes Team Medical Coding Coordinator at Humana

Puerto Rico

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

NoVisa

HealthcareIndustries

Requirements

Reside in Puerto Rico, no more than one hour away from Humana’s headquarters at Avenida Luis Muñoz Rivera 383, San Juan, PR 00918
Fluent in English with the ability to speak, read, and write without limitations or assistance (must pass Language Proficiency Assessment in English/Spanish, including Interagency Language Rating (ILR) test)
Coding Certification: AAPC CPC (no Apprentice) or AHIMA CCS
Minimum of 3 years' experience as a Certified Medical Coder
Demonstrate ability to problem-solve complex coding issues
Experience with Medicare and Medicaid coding guidelines
Strong data entry and attention to detail skills with the ability to manage multiple tasks in a fast-paced setting with competing priorities
Intermediate experience with Microsoft Word, Excel, Outlook, and Teams
Preferred Qualifications
Associate or Bachelor’s Degree
5 or more years of experience as a Certified Medical Coder
MS-DRG auditing or APR auditing experience
Passionate about contributing to an organization focused on continuously improving consumer experiences
Experience in a production driven environment

Responsibilities

Review clinical information from medical records and assign appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records
Ensure accurate application of coding guidelines and maintain compliance with regulatory requirements
Support operational efficiency in claims management
Research, review, and educate providers regarding disputes on adjudicated claims involving code editing denials or recoveries
Analyze, enter, and manipulate data within relevant databases
Respond to or clarify internal requests for medical information
Exercise discretion and judgment in prioritizing requests, interpreting, and adapting procedures
Perform advanced administrative, operational, and customer support duties requiring independent initiative and judgment under limited guidance

Skills

ICD-10-CM

CPT

Medical Coding

Claims Adjudication

Code Editing

Disputes Resolution

Data Analysis

Regulatory Compliance

Customer Support

Administrative Processes

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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