Code Edit Disputes Supervisor

📋 Description

• • As a Code Edit Disputes Supervisor at Humana Inc., you will play a pivotal role in ensuring the accuracy and fairness of our claims adjudication processes, specifically focusing on code editing disputes. This position offers a unique opportunity to lead a dedicated team, drive process improvements, and contribute to a culture of continuous enhancement within a leading healthcare organization.
• • Your primary responsibility will be to oversee the daily operations of the medical coding disputes team. This includes managing schedules, ensuring adherence to established plans, and maintaining the smooth flow of work to meet departmental objectives. You will be instrumental in coordinating with Leads to guarantee consistency in processes and procedures across all teams, fostering a unified and efficient approach.
• • A key aspect of this role involves leading continuous improvement initiatives. You will be tasked with evaluating existing systems and workflows, identifying areas for enhancement, and implementing innovative solutions to streamline operations. This proactive approach to process optimization is crucial for maintaining our competitive edge and ensuring high-quality service delivery.
• • You will be responsible for implementing, monitoring, and continually improving program operational processes. This requires a deep understanding of our current systems and a forward-thinking mindset to anticipate future needs and challenges. By rethinking routine processes and actively seeking new ideas, you will contribute to simplifying and improving team workflows.
• • A significant part of your role will involve identifying trends by conducting deep dives into coding dispute issues. This analytical approach will enable you to pinpoint opportunities for improvement, address root causes of disputes, and provide valuable insights to management. Your ability to translate data into actionable strategies will be highly valued.
• • You will also be responsible for holding team members accountable for adhering to established policies and procedures. This includes providing guidance, support, and constructive feedback to ensure the team operates with integrity and efficiency, upholding Humana's commitment to excellence.
• • This role requires a strong understanding of medical coding principles and the ability to apply them within the context of code editing disputes. You will be expected to work within thorough, prescribed guidelines and procedures, utilizing independent judgment to analyze variable factors and solve basic problems.
• • Collaboration is key in this position. You will work closely with management and top professionals/specialists to select the most effective methods, techniques, and analytical approaches for resolving complex coding disputes.
• • The ideal candidate will possess a passion for contributing to an organization dedicated to continuously improving consumer experiences. Your leadership will directly impact the satisfaction of our providers and the efficiency of our claims processing, ultimately benefiting the members we serve.
• • This is a remote position, offering the flexibility to work from home nationwide. While occasional travel to Humana's offices for training or meetings may be required, the majority of your work will be conducted remotely, allowing for a healthy work-life balance.
• • You will be expected to maintain a dedicated workspace that ensures the privacy and security of member Protected Health Information (PHI) and HIPAA information, adhering to all company policies regarding data protection.
• • The work hours are typically Monday through Friday, 8 hours per day. While training hours may differ, once independent, associates are expected to start work each day between 6 AM and 9 AM EST, regardless of their home time zone, ensuring consistent coverage and collaboration.
• • You will be part of a Fortune 100 company that values associate engagement and well-being, offering excellent professional development and continued education opportunities to support your career growth.
• • This role is critical in managing the resolution of code edit disputes, ensuring that providers receive fair and accurate adjudication of their claims. Your leadership will directly influence the efficiency and effectiveness of this vital function within Humana's operations.