• The 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 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 Payment Integrity Coding Professional monitors and analyzes Code Edit operational processes and performance metrics 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
• WORK HOURS: Standard business hours are Monday - Friday, 8 hours/day, 5 days/week
• Core business hours are 8AM - 5PM Eastern time
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required

Scheduled Weekly Hours

• AAPC or AHIMA Coding Certification
• Minimum 3 years post certification experience utilizing coding guidelines by reading and interpreting claims
• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Strong attention to detail
• Can work independently and determine appropriate courses of action
• Ability to handle multiple priorities
• Capacity to maintain confidentiality
• Excellent communication skills both written and verbal
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided

Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct coding initiatives, national benchmarks, and industry standards

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
• 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 $65,000 - $88,600 per year

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