Senior Payment Integrity Coding Professional

About the Role

Employment Type: Full time

Become a part of our caring community and help us put health first. The Senior Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim payment.

The Senior Payment Integrity Professional work assignments require in-depth research, cross departmental collaboration, independent determination of the appropriate course of action, and involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Payment Integrity Coding Professional monitors and analyzes Code Edit performance metrics and operational processes to identify inefficiencies and opportunities for improvement. Partners with internal business partners to support business initiatives, including identifying the root cause of challenges, designing solutions to the challenges, and implementing solutions. Builds and maintains strong internal working relationships at all levels of the organization and across the Enterprise; leverages these relationships in helping to drive innovation and effective operations for Humana. Engages in implementations and/or ad hoc projects, within assigned scope of responsibilities to understand requirements, to support and guide team members on priorities and help manage risks and escalations.

Use your skills to make an impact.

Work Style & Hours

• WORK STYLE: Remote/Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• WORK HOURS: Standard business hours are Monday - Friday, 8 hours/day, 5 days/week. Core business hours are 8AM - 5PM Eastern time.

Required Qualifications

• AAPC or AHIMA Coding Certification
• 5 or more years work experience utilizing coding guidelines by reading and interpreting claims
• Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct coding initiatives, national benchmarks, and industry standards
• Excellent data analysis and experience working with SQL, Power BI, and Excel
• Excellent verbal and written presentation skills with ability to distill complex data into clear insights for all levels of the organization

Preferred Qualifications

• Bachelor's degree
• Experience leading people, projects, and/or processes
• Experience using the following systems: CAS, MTV, and Code Edit vendor tools
• Experience in a fast paced, metric driven operational setting

Additional Information

• 100% remote
• Standard business hours are Monday - Friday, 8 hours/day, 5 days/week. Core business hours are 8AM - 5PM Eastern time.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Scheduled Weekly Hours: 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.