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

The Claims Financial Recovery Coding Specialist /Medical Coding Coordinator 2 for the Financial Recovery Team, is responsible for analysis of overpaid claims and makes appropriate determinations based on strong knowledge of coding guidelines, claims procedures, contract provisions, and CMS guidelines.

The Claims Financial Recovery Coding Specialist / Medical Coding Coordinator 2

Maintains required standards of performance and productivity to meet turnaround times and service level agreements (SLAs)
Stays current with most recent coding changes and guidance from CMS, AHA Coding Clinics, etc.
Completes required Continuing Education hours to maintain CPC certification.
Performs Root Cause analysis and pursues opportunities to mitigate claim overpayments.
Works with other departments such as Claims, Finance, Provider Services, and Provider Configuration and Load
Performs tasks within the Financial Recovery Life Cycle to recuperate overpaid claims from providers

Use your skills to make an impact

Required Qualifications

2 or more years of medical claims knowledge and/or claims processing experience within the healthcare industry.
2 or more years of experience as a certified medical coder (AAPC Coding Certified- cannot be an “apprentice” CPC-A)
Proficiency in Microsoft Office: Word, Excel and Outlook
MUST be able to work in Eastern Standard Time Zone
Schedule: Monday to Friday from 8 am to 5 pm EST. with flexibility in start/end time. Overtime as needed based on business needs.

Preferred Qualifications

Financial Recovery Experience (sending/receiving overpayments correspondence, Posting refund checks, offsetting claim payments, etc.)
Auditing experience or working within a similar environment that requires a determination based on research.
Ability to quickly learn new systems.
Proven ability to utilize analytical thinking in determining root cause.
Experience in interpreting provider contract language
Experience with DRG & APC calculations
Ability to work in a production environment.
Ability to manage and prioritize tasks based on business need.
Strong written communication

Additional Information

Schedule: Monday to Friday from 8 am to 5 pm EST. with flexibility in start/end time. Overtime as needed based on business needs.
Training: 100% Virtual
MUST be able to work in Eastern Standard Time Zone
Position is Remote

As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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 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 Guidance

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home 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; 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

Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

#LI-BB1

Scheduled Weekly Hours

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.

$37,200 – $51,200 per year

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.

About us

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our 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 jobs

Part Time Healthcare Claims Denials Specialist - $37,200 – $51,200/yr

Claims Financial Recovery Coding Specialist