Code Edit Professional, Payment Integrity

About this role

Become a part of our caring community   Ready for a great career move? The Code Edit Management Organization has a new Payment Integrity Professional 2 opening available. The Payment Integrity Professional 2 utilizes vendor platforms, claims processing platforms, and data to collaborate with key internal and external business stakeholders, while supporting claims code editing pre and post-implementation and functionality. The opportunity contributes to the overall goal of claims cost reduction and is available for WAH nationwide.

Where you Come In  • Foster relationships between Code Edit Management, internal stakeholders and multiple external code editing vendors

• Support of new code edit reviews, testing, implementation and maintenance management

• Management and resolution of code edit stakeholder inquiries

• Drive process improvements and ensure successful run of business

Use your skills to make an impact   WORK STYLE: Remote, work at home. Minimal travel possible: Approximately 1-2x/year for trainings, meetings, conferences. WORK HOURS: Monday-Friday, 8 hours/day, 5 days/week, in the employee's time zone. Flexibility will be required to meet business needs.

Required Qualifications • Experience with forward-facing client and/or vendor relationship management

• Experience facilitating meetings with internal and/or external stakeholders

• Data analysis and/or research experience

• Proficient in managing diverse priorities, adept at swiftly transitioning between tasks based on urgency and demand

• Comfortable navigating and making decisions in a dynamic and everchanging environment

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

• Problem-solving abilities, including thinking outside the box and collaborating with others to achieve optimal outcomes

• Ability to work both independently and within a team structure, with minimal supervision

• Analytical Thinking/Problem-solving abilities, including thinking outside the box and collaborating with others to achieve optimal outcomes

• Strong attention to detail

• Proficiency in verbal/written communication

• Ability to operate in a fast paced, agile, metric driven operational setting

• Commitment to upholding ethical standards and professional integrity in all interactions, including ability to maintain confidentiality

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

​ Preferred Qualifications • STRONGLY PREFERRED: Prior experience utilizing code edit vendor tools

• STRONGLY PREFERRED:  Advanced Excel knowledge (H-lookups, V-lookups, pivot tables, etc)

• Prior experience working with external vendors and/or internal stakeholders

• Prior experience with Humana code edit claims processes 

• Working knowledge of Microsoft Office Programs: PowerPoint and OneNote

• Prior experience in THOR Rule creation and/or processes

• Prior experience leading projects, and/or processes

• Prior experience analyzing medical claims data

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

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.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   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 ran

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