Code Edit Disputes Medical Coder

📋 Description

• • Join Humana Inc., a Fortune 100 company dedicated to putting health first, as a Medical Coding Coordinator in our Code Edit Disputes team. This fully remote, nationwide position offers a unique opportunity to leverage your expertise in medical coding to resolve provider disputes and contribute to a seamless healthcare experience for our members.
• • In this critical role, you will be responsible for meticulously reviewing and analyzing adjudicated claims that have resulted in code editing-related denials or financial recoveries. Your primary objective will be to investigate these disputes, identify the root causes, and provide clear, educational feedback to healthcare providers, ensuring accurate coding practices and minimizing claim rejections.
• • You will delve into a variety of medical records, extracting essential clinical information. This data will then be used to assign appropriate procedural terminology and medical codes, adhering strictly to industry standards such as ICD-10-CM and CPT.
• • A significant aspect of your role will involve analyzing, entering, and manipulating data within our internal databases. This requires a keen eye for detail and the ability to manage complex datasets efficiently.
• • You will serve as a key point of contact for internal requests for medical information, responding promptly and accurately to ensure all inquiries are addressed with the highest level of professionalism and expertise.
• • This position demands a high degree of independent initiative and judgment. You will be expected to prioritize requests, interpret and adapt procedures, and apply your in-depth knowledge of administrative processes and organizational protocols with limited guidance.
• • The role requires problem-solving skills to address complex coding issues that arise during dispute resolution. Your ability to think critically and develop effective solutions will be paramount.
• • You will work closely with Medicare and Medicaid coding guidelines, ensuring all actions and recommendations are compliant with these regulations.
• • As a Medical Coding Coordinator, you will manage multiple tasks in a fast-paced environment, effectively balancing competing priorities while maintaining a high standard of accuracy and quality.
• • Proficiency in intermediate-level Microsoft Office Suite (Word, Excel, Outlook) and Microsoft Teams is essential for daily operations, communication, and data management.
• • This is a remote position, allowing you to work from anywhere in the United States. While the role is primarily home-based, occasional travel to Humana's offices for training or important meetings may be required.
• • Humana values associate engagement and well-being, offering excellent professional development and continued education opportunities to support your career growth.
• • You will operate within typical business hours, Monday through Friday, dedicating 8 hours per day, 5 days a week to your responsibilities.
• • The role requires a dedicated workspace that is free from ongoing interruptions to protect member Protected Health Information (PHI) and ensure HIPAA compliance.
• • Humana provides necessary telephone equipment to meet business requirements for remote associates.
• • For associates residing in California, Illinois, Montana, or South Dakota, Humana provides a bi-weekly payment to offset internet expenses.
• • The hiring process includes an innovative HireVue interview, allowing for flexible scheduling and efficient assessment of your skills and experience.
• • This position is integral to Humana's mission of making it easier for millions of people to achieve their best health by ensuring accurate claims processing and supporting healthcare providers with clear, actionable guidance.
• • Your contributions will directly impact the efficiency of our claims processing and the satisfaction of our provider network, reinforcing Humana's commitment to quality care and service.
• • You will be part of a supportive and caring community, working collaboratively with a team dedicated to improving consumer experiences and driving positive health outcomes.
• • This role offers a competitive salary range and comprehensive benefits designed to support your whole-person well-being.