Code Edit Disputes Medical Coder
About The Position
The Medical Coding Coordinator supports the Code Edit Disputes team, which reviews and educates providers when they dispute adjudicated claims involving code-editing denials or financial recoveries. The role extracts clinical information from medical records and assigns appropriate procedural terminology and medical codes, including ICD-10-CM and CPT, to patient records. It also analyzes, enters, and manipulates database information and responds to or clarifies internal requests for medical information. The position performs advanced administrative, operational, and customer-support duties requiring initiative and judgment, and may use intermediate mathematical skills. Decisions generally concern methods, tactics, and processes for completing administrative tasks and projects. The coordinator regularly exercises discretion in prioritizing requests and interpreting or adapting procedures, processes, and techniques, and works with limited guidance based on prior experience and knowledge of administrative processes and the organization. This is a remote, work-at-home role available from anywhere in the United States. Occasional travel to Humana offices for training or meetings may be required. Typical hours are Monday through Friday, eight hours per day, with 40 scheduled hours per week. A dedicated work area without ongoing interruptions is required to protect member PHI and HIPAA information. Home internet must meet the stated speed requirements; Humana may require an upgrade if needed for business purposes.
Requirements
- AAPC CPC coding certification; Apprentice status is not accepted.
- At least 3 years of experience as a Certified Medical Coder.
- 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 with competing priorities.
- Intermediate experience with Microsoft Word, Excel, Outlook, and Teams.
- Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.
- Home internet with at least 25 Mbps download and 10 Mbps upload speed.
Nice To Haves
- Bachelor's degree.
- 5 or more years of experience as a Certified Medical Coder.
- CPMA certification.
- MS-DRG auditing or APR auditing experience.
- Passion for contributing to an organization focused on continuously improving consumer experiences.
- Experience in a production-driven environment.
Responsibilities
- Extract clinical information from a variety of medical records.
- Assign appropriate procedural terminology and medical codes, such as ICD-10-CM and CPT, to patient records.
- Analyze, enter, and manipulate database information.
- Respond to or clarify internal requests for medical information.
- Review and address code-edit-related disputes involving adjudicated claims, including denials or financial recoveries.
- Educate providers in connection with code-edit disputes.
- Prioritize requests and interpret or adapt administrative procedures, processes, and techniques.
- Manage administrative, operational, and customer-support tasks and projects.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Professional development
- Continued education
- Bi-weekly internet-expense payment for associates who live and work from home in California, Illinois, Montana, or South Dakota
- Telephone equipment appropriate to the job's business requirements
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
