Code Edit Disputes Medical Coder

Become a part of our caring community and help us put health first The Medical Coding Coordinator 3 reviews clinical information from medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. This position ensures accurate application of coding guidelines, maintains compliance with regulatory requirements, and supports operational efficiency in claims management. The Medical Coding Coordinator 3 performs advanced administrative, operational, and customer support duties that require independent initiative and judgment. This role is responsible for researching, reviewing, and educating providers regarding disputes on adjudicated claims involving code editing denials or recoveries. The coordinator analyzes, enters, and manipulates data within relevant databases, and responds to or clarifies internal requests for medical information. Decisions in this role typically focus on methods and processes for completing administrative tasks and projects. The Medical Coding Coordinator 3 regularly exercises discretion and judgment in prioritizing requests, interpreting, and adapting procedures, and works under limited guidance, drawing upon extensive knowledge and experience with administrative and organizational processes. Use your skills to make an impact WORK STYLE: Remote, work at home. While this is a remote position, occasional travel to Humana's office in San Juan, PR for training or meetings may be required. WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day and 5 days/week. Required Qualifications • This is a remote position in Puerto Rico Candidates must reside in Puerto Rico, no more than one hour away from Humana's headquarters, located at Avenida Luis Muñoz Rivera 383, San Juan, PR 00918. • Must be fluent in English with the ability to speak, read, and write in that language without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English / Spanish (see Language Proficiency Testing below) • Coding Certification required: AAPC CPC (no Apprentice) or AHIMA CCS • Minimum of 3 years' experience as a Certified Medical Coder • Demonstrate ability to problem-solve complex coding issues • Experience with Medicare and Medicaid coding guidelines • Strong data entry and attention to detail skills with the ability to manage multiple tasks in a fast-paced setting with competing priorities • Intermediate experience with bolthires Word and Excel, Outlook, and Teams Preferred Qualifications • Associate or Bachelor's Degree • 5 or more years of experience as a Certified Medical Coder • MS-DRG auditing or APR auditing experience • Must be passionate about contributing to an organization focused on continuously improving consumer experiences • Experience in a production driven environment Additional Information Language Proficiency Testing. Must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. • *PLEASE MAKE SURE YOU ATTACH YOUR RESUME TO YOUR APPLICATION (PDF OR WORD FORMAT) PLEASE SUBMIT YOUR RESUME IN ENGLISH 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 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. $36,200 - $49,400 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 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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. Apply tot his job Apply tot his job Apply tot his job