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

Where you Come In 
Humana is looking for an experienced Outpatient Evaluation & Management (E&M) medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Outpatient Coding Auditor (E&M) - Coding Disputes Team opportunity with Humana.
The Outpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate E&M level of service assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. 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. Follows established guidelines/procedures.

What Humana Offers 
We are fortunate to offer a remote opportunity for this job.  Our Fortune 100 Company values associate engagement & your well-being.  We also provide excellent professional development & continued education.  

This is a Remote anywhere in the US 40 hour per week role and the work hours will be 8 hours a day Monday to Friday 

Use your skills to make an impact
 

WORK STYLE: Remote, work at home

WORK HOURS: Typically Monday-Friday, 8 hours/day, 5 days per week-- depending on business needs.

Required Qualifications – What it takes to Succeed
•    CPC or CCS Certification (should have held at least one of these qualifications for 4 years)
•    Evaluation and Management coding/auditing experience including Emergency Room and physician services.
•    Minimum of 3 years’ experience in performing E&M outpatient coding reviews/ audits in health insurance and/or hospital settings
•    Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
•    Strong attention to detail
•    Can work independently and determine appropriate course 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

Preferred Qualifications
•    Associate's Degree or higher in Health Information Management (HIM)

•    Experience in outpatient coding/auditing for APC/ infusions

•    Prior experience in CAPI (Claims Administration & Payment Integrity)
•    Experience in Financial Recovery
•    Experience in a fast paced, metric driven operational setting

Additional Information - How we Value You  

• Benefits starting day 1 of employment 

• Competitive 401k match  

• Generous Paid Time Off accrual  

• Tuition Reimbursement 

• Parent Leave 

WAH requirements:

•   Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
•    A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.  
•    Satellite and Wireless Internet service is NOT allowed for this role.
    A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format 

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
 

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 Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
 

If participating in a SMS Text interview, you will be asked