Become a part of our caring community and help us put health first
 

The Senior Provider Reimbursement Professional - Certified Medical Coder performs research, analysis, documentation, and interpretation for the provider reimbursement programs for an organization that provides health insurance. The Senior Provider Reimbursement Professional works assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Role Overview

• Identifies reimbursement policy and process recommendations (primarily with respect to proposed new code edits and the specifics of existing code edits that are reviewed), ensuring compliance with government regulations, contractual considerations, and relevant business decisions.
• Analyzes provider reimbursement patterns and trends.
• Begins to influence department’s strategy.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
• Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact
 

Required Qualifications – What it takes to Succeed

• 2 years experience with a coding certification (Industry-recognized coding certification from the AAPC and/or AHIMA)
• Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, and HCPCS
• Medical Code editing experience
• Comprehensive knowledge of Microsoft Word, Outlook and Excel
• Strong attention to detail, excellent time management and organizational skills
• Ability to work independently under general instructions and with a team

Preferred Qualifications

• BS in healthcare or business-related field
• Knowledge of internal Medical Coverage Policies and Claims Payment Policies
• CAS claims processing experience
• Experience in data analysis and trend monitoring

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is required
• 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
• 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

Additional Information

• Hours: Monday-Friday with a start time between the hours of 6am-9am EST (Candidates must be flexible and available to work in the Eastern Standard Time Zone no matter the time zone you reside in)

Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue 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.

Social Security Task

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.  

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

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.

 

$59,300 - $80,900 per year

 

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