Payment Integrity Coding Professional

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

The Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim payment.

The Payment Integrity Professional work assignments require in-depth research, cross departmental collaboration, independent determination of the appropriate course of action, and involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Payment Integrity Coding Professional monitors and analyzes Code Edit operational processes and performance metrics to identify inefficiencies and opportunities for improvement. Partners with internal business partners to support business initiatives, including identifying the root cause of challenges, designing solutions to the challenges, and implementing solutions. Builds and maintains strong internal working relationships at all levels of the organization and across the Enterprise; leverages these relationships in helping to drive innovation and effective operations for Humana. Engages in implementations and/or ad hoc projects, within assigned scope of responsibilities to understand requirements, to support and guide team members on priorities and help manage risks and escalations.

Use your skills to make an impact
 

WORK STYLE: Remote/Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

WORK HOURS: Standard business hours are Monday - Friday, 8 hours/day, 5 days/week. Core business hours are 8AM - 5PM Eastern time.

Required Qualifications

• AAPC or AHIMA Coding Certification

• Minimum 3 years post certification experience utilizing coding guidelines by reading and interpreting claims

• Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct coding initiatives, national benchmarks, and industry standards

• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel

• Strong attention to detail

• Can work independently and determine appropriate courses 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

• Bachelor's degree

• Experience leading people, projects, and/or processes

• Experience using the following systems: CAS and Code Edit vendor tools

• Experience in a fast paced, metric driven operational setting

Additional Information

• 100% remote role

• Standard business hours are Monday - Friday, 8 hours/day, 5 days/week. Core business hours are 8AM - 5PM Eastern time.

Work at Home Requirements

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

•            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

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly 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 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 a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

 

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.

 

$65,000 - $88,600 per year

 

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

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 01-04-2026

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.