Job Summary
Become a part of Humana’s caring community and help put health first. The Payment Integrity Professional 2 plays a key role in reducing costs and improving accuracy in medical claim payments. This role requires coding expertise, data analysis, and cross-departmental collaboration to identify and implement code edits, reduce errors, and streamline claims processing.
Responsibilities
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Review claims using CPT, ICD, HCPCS codes following CMS/Medicaid guidelines
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Identify data anomalies and propose new code edits
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Collaborate with internal teams and external code-editing vendors
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Ensure compliance and support continuous process improvements
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Lead independent investigations and make decisions with minimal supervision
Required Qualifications
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Certified Professional Coder (AHIMA or AAPC)
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2+ years’ experience interpreting or submitting medical claims
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Strong knowledge of CPT®, HCPCS, ICD codes and CMS/Medicaid guidelines
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Proficient in MS Word, Excel, PowerPoint
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Strong analytical, communication, and multitasking skills
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Ability to work independently in a fast-paced environment
Preferred Qualifications
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Experience using code editing vendor tools
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Project or process leadership experience
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Familiarity with Humana’s systems and editing processes
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Knowledge of Microsoft Access
Remote Work Requirements
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Dedicated, quiet workspace to protect PHI/HIPAA
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Reliable internet: 25 Mbps download / 10 Mbps upload minimum
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Internet allowance provided (CA, IL, MT, SD only)
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Humana provides necessary phone equipment
Benefits
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Medical, dental, and vision insurance
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401(k) with company match
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Paid time off, holidays, and volunteer leave
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Paid parental/caregiver leave
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Short/long-term disability & life insurance
About Humana
Humana Inc. (NYSE: HUM) is committed to helping millions of people achieve their best health. Through insurance services and CenterWell care, Humana provides accessible, high-quality support to Medicare, Medicaid, and military families across the U.S.
Equal Opportunity Statement
Humana is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, disability, or veteran status.
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