Code Edit Disputes Medical Coder Job at Humana, San Juan, TX

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  • Humana
  • San Juan, TX

Job Description

Senior Recruiter/Strategic Sourcer /Talent Acquisition at Humana 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 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 at Avenida Luis Muñoz Rivera 383, San Juan, PR 00918. Must be fluent in English with the ability to speak, read, and write without limitations or assistance. If selected, you will be required to take a Language Proficiency Assessment in English / Spanish. Coding Certification required: AAPC CPC (no Apprentice) or AHIMA CCS Minimum 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 with ability to manage multiple tasks in a fast‑paced setting with competing priorities Intermediate experience with Microsoft Word, Excel, Outlook, and Teams Preferred Qualifications Associate or bachelor’s degree 5 or more years of experience as a Certified Medical Coder MS‑DRG or APR auditing experience Passionate about contributing to an organization focused on continuously improving consumer experiences Experience in a production‑driven environment 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. Travel: Occasionally required to travel to Humana’s offices for training or meetings. Scheduled Weekly Hours 40 Pay Range $36,200 - $49,400 per year Seniority level Mid‑Senior level Employment type Full‑time Job function Sales and Business Development Insurance #J-18808-Ljbffr Humana

Job Tags

Full time, Apprenticeship, Work at office, Remote work, Work from home, Monday to Friday,

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