Payment Integrity Professional

Humana

1d • $65,000 - $88,600 • Remote

About The Position

The Payment Integrity Professional 2 contributes to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim payment. The Payment Integrity Professional 2 work assignments require in depth research, cross departmental collaboration and independent determination of the appropriate courses of action. The Payment Integrity Professional 2 contributes to overall cost reduction by utilizing coding knowledge to identify/validate new code edit opportunities in a timely fashion to ensure claims process correctly the first time. Expert level of coding knowledge specific to Medicare and Medicaid guidelines is a must. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Fosters relationships between Code Edit Management, internal stakeholders and multiple external code editing vendors. Drives process improvements and ensures successful run of business. Follows established guidelines/procedures. This position is a Remote, Work At Home role.

Requirements

• Certified Professional Coder with either AHIMA or AAPC certification
• Minimum of 2 years of experience utilizing coding guidelines, submitting, reading and/or interpreting claims
• Distinguished knowledge of American Medical Association Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases (ICD) code sets
• Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct-coding initiatives, national benchmarks and industry standards
• Comfortable presenting to a large audience
• Analytical thinking
• Strong attention to detail
• Can work independently and determine appropriate courses of action
• Comfortable presenting to a large audience​

Nice To Haves

• Experience using code editing vendor tools
• Experience leading projects and/or processes
• Ability to maintain a positive mindset
• Knowledge of Microsoft Office Programs Access and Humana systems
• Experience in a fast paced, metric driven operational setting
• Familiarity with Humana Code Editing Processes

Responsibilities

• Utilizing code editing guidelines and data anomalies to ensure correct claim payment.
• Utilizing coding knowledge to identify/validate new code edit opportunities in a timely fashion to ensure claims process correctly the first time.
• Fostering relationships between Code Edit Management, internal stakeholders and multiple external code editing vendors.
• Driving process improvements and ensuring successful run of business.
• Following established guidelines/procedures.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, 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: No Education Listed