Senior PPI Professional - Inpatient Coding Disputes

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The Senior Payment Integrity Professional - Inpatient Coding Disputes on the Disputes Team consults and collaborates with coding professionals across departments to ensure high accountability of coding disputes outcomes for timeliness, compliance and quality.

• Will be a SME (Subject Matter Expert) medical coder with in-depth experience in inpatient coding audits (MSDRG/APDRG)

• Contributes to overall accuracy and compliance of coding disputes reviews ensuring that all appropriate coding guidelines are adhered to and will be able to speak to inpatient coding review outcomes to a variety of audiences

• Leverages advanced auditing expertise to guide onshore and offshore DRG coding disputes auditors, reviews disputes escalations and clarification requests

• Manages multiple priorities, collaborates across teams, and ensures timely, accurate inventory aspecto

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits

• Dental Benefits

• Vision Benefits

• Health Savings Accounts

• Flex Spending Accounts

• Life Insurance

• 401(k)

• PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental Leave, caregiving Leave, and weekly well-being time

• And more

• 5+ years holding one of these Coding Credentials from AHIMA:
  CCS/
  RHIT/ RHIA

• 5+ years' work experience reading and interpreting claims

• 2+ years verifiable experience in MSDRG disputes/audits

• 2+ years of verifiable SME and/or leadership experience within the last few years in provider/payer inpatient auditing

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• Verifiable experience working with and supporting onshore and offshore MSDRG vendors/ staff

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

• Excellent communication skills both written and verbal

• High level of productivity with the ability to turn-around requests quickly and effectively

• Strong attention to detail
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• Experience leading people, projects, and/or processes

• 5>

  Experience in Financial Recovery

• Experience in a fast paced, metric driven operational setting

Work at Home/Remote Requirements

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home vytvo or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.

• Wireless, Wired Cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)

• Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception  associates who live or work from Home in the state of California, Illinois,mtree, or South Dakota. 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 theirumiem position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third‑party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision‑making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre‑recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre‑recorded interview, you will…