Code Edit Disputes Team Medical Coding Coordinator

Humana • PR

79d • $36,200 - $49,400

About The Position

The Medical Coding Coordinator 3 reviews clinical information from medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. This position ensures accurate application of coding guidelines, maintains compliance with regulatory requirements, and supports operational efficiency in claims management. The Medical Coding Coordinator 3 performs advanced administrative, operational, and customer support duties that require independent initiative and judgment. This role is responsible for researching, reviewing, and educating providers regarding disputes on adjudicated claims involving code editing denials or recoveries. The coordinator analyzes, enters, and manipulates data within relevant databases, and responds to or clarifies internal requests for medical information. Decisions in this role typically focus on methods and processes for completing administrative tasks and projects. The Medical Coding Coordinator 3 regularly exercises discretion and judgment in prioritizing requests, interpreting, and adapting procedures, and works under limited guidance, drawing upon extensive knowledge and experience with administrative and organizational processes.

Requirements

• Must reside in Puerto Rico, no more than one hour away from Humana’s headquarters.
• Fluent in English with the ability to speak, read, and write in that language without limitations or assistance.
• Coding Certification required: 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.
• Ability to manage multiple tasks in a fast-paced setting.
• Intermediate experience with Microsoft Word, Excel, Outlook, and Teams.

Nice To Haves

• 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.
• Ensure accurate application of coding guidelines and maintain compliance with regulatory requirements.
• Support operational efficiency in claims management.
• Perform advanced administrative, operational, and customer support duties.
• Research, review, and educate providers regarding disputes on adjudicated claims.
• Analyze, enter, and manipulate data within relevant databases.
• Respond to or clarify internal requests for medical information.

Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, volunteer time off.
• Paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees