Outpatient Coding Auditor Surgical Specialty - Remote/Virtual in US

Profile

Description

The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Payment Integrity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Where you Come In

Humana is looking for an experienced medical coding reviewer to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 500 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Outpatient Coding Auditor (Surgical Specialty) - Outcomes Assurance Team opportunity with Humana.

The Payment Integrity Professional 2/Outpatient Coder contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. 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.

Required Qualifications - What it takes to Succeed


Certified Coding Credentials from AHIMA or AAPC to include RHIT, CCS, CCS-P or CPC
Minimum of 3 years' work experience reading and interpreting claims
Minimum of 3 years' experience in performing outpatient coding quality audits in health insurance and/or hospital settings including emergency room, same day surgery or observation settings or prior experience working outpatient surgery coding-related disputes and trending results
Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
Strong attention to detail and ability to handle multiple priorities
Can work independently and determine appropriate course of action
Capacity to maintain confidentiality
Excellent communication skills both written and verbal


Preferred Qualifications


Associate's Degree or higher in Health Information Management (HIM) or related field
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
Go365 perks for well-being

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M


Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. 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 for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

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