Payment Integrity Professional

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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.

Use your skills to make an impact

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: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week.
Required Qualifications

- 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​

Preferred Qualifications

- 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

Additional Information
Work at Home Requirements

- 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

- 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.

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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

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Tex