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The Senior Medical Coding Professional acts as a Subject Matter Expert (SME) for the clinical review team, supporting processes and trends to assist team in meeting organizational goals. The Senior Medical Coding Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Medical Coding Professional confirms appropriate Outpatient and Physician CPT Coding. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

• Reviewing provider escalations

• Reviewing staff monthly QA review variances

• Developing new review concepts

• Daily inventory monitoring and assignment of escalated inventory

• Research on guidelines – CMS, AAPC, etc

• Training new coders

• Responsible for updating and maintaining processes/resources/guidelines in OneNote & Mentor

• Point of contact for coders

• Assist coders with coding or technical issues

• Team Engagement

• Assist with onshore and home office reviews when/if needed

• Assist with assignments as appropriate per leader direction

Use your skills to make an impact

WORK STYLE: Remote/Work at home but with the possibility of minimal travel for on-sites, meetings, conferences, and/or trainings.

WORK HOURS: Associates will work on EST, regardless of where the associate resides. Work hours can vary, slightly, but all associates start between 6AM-9AM EST and work 8 hours/day, 5 days/week. Some flexibility is available, depending on business needs.

Required Qualifications

• AAPC or AHIMA Coding Certification, (CPC, COC, ROCC, RHIA, RHIT, CCS) with at least 4 years post-certification experience focused on outpatient surgical coding/auditing

• Radiation Oncology Experience

• Chemotherapy/Infusion Experience

• Outpatient Specialty Surgery and Procedure experience

• Proven ability analyzing and solving complex issues

• Comfortable working with minimal supervision and exercising latitude in decision making

• Strong attention to detail, can work independently and determine appropriate course of action, and ability to handle multiple priorities

• Ability to work independently and manage workload

• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information

• Comprehensive knowledge of MS Word, Excel, and PowerPoint

• Strong written and verbal communication skills, strong analytical, organizational and time management skills

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Candidates must be able to work business hours aligning to EST

Preferred Qualifications

• Bachelor's Degree

• Previous leadership experience

• Bilingual English/Spanish

• 5+ years prior auditing experience

• Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology

• Ambulatory Payment Classification (APC) coding experience

• Experience in prospective payment methodologies

• Experience with the Claims Life Cycle including Accounts receivable

• 3M coding software experience

Additional Information

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

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.

$71,100 - $97,800 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: 01-30-2025

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.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.