Job Description:
Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: Certified Coder Consultant
Assignment: Provider Network Operations
Location: Louisville, KY (can be Work-at-Home)

Are you a fit?
Are you a certified medical coder? Do you enjoy conducting chart review, coding and working with providers? Are you ready to take your coding knowledge to the next level?

Assignment Capsule

As a Provider Network Operations consultant you will: provide strategic leadership and consultation services for the PNO area. You will complete analyses and prepare disclosure materials while interacting and building partnerships with Humana's code editing, communications, and information technology teams and with external vendors.

• Assist vendors, providers and Humana market offices with questions related to coding and billing for hospital bill audits, specialty audits, Diagnosis-Related Group audits, and Skilled Nursing Facility audits
  
• Develop audit tools and conduct reviews at providers' offices
  
• Act as a liaison between multiple business partners to identify and resolve problems and concerns
  
• Verify the accuracy of diagnosis information submitted on claims/encounters for the purposes of risk adjustment
  
• Use your claims knowledge to build a greater understanding of disclosure requirements for information about code editing logic
  
• Triage assignments based on urgency, utilizing your knowledge to ensure escalation when necessary

• Builds Trust: You honor your word by doing what you say you are going to do.
  
• Implementation/Execution: You are good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
  
• Innovate: You introduce new ideas and processes which improve performance and productivity.
  
• Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.

• Coding certification (RHIT, CCS, CPC, ect.)
  
• Inpatient/DRG hospital coding experience and/or DRG review with up-coding experience
  
• Extensive knowledge of multiple types of Medical coding, such as ICD, CPT, HCPCS and DRG assignment
  
• Basic proficiency with MS Office (Excel and word)
  
• Strong written and verbal communication skills
  
• This role may require some local and regional travel (travel is planned, approx 20%)
  
  Role Desirables
  
  • BS in healthcare or business related field
    
  • RAC Audit Experience
    
    • Knowledge of 3M encoder software
      
      Reporting Relationships
      
      • You will report to a Manager.
        
      
      
      Years of Experience Required: At Least 1 Year
      
      Expected Travel Time: About 25%