Code Edit Disputes Medical Coder

Overview

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.

Responsibilities

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.

Work Style

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

WORK HOURS : Typical business hours are Monday-Friday, 8 hours / day and 5 days / week.

Required Qualifications

• Remote position in Puerto Rico : Candidates reside in Puerto Rico, no more than one hour away from Humana's headquarters at Avenida Luis Muñoz Rivera 383, San Juan, PR 00918.
• Language : Must be fluent in English with ability to speak, read, and write in that language. If selected, you will be required to take a Language Proficiency Assessment in English / Spanish.
• Coding Certification : AAPC CPC (no Apprentice) or AHIMA CCS
• Experience : Minimum of 3 years\' experience as a Certified Medical Coder
• Skills : Demonstrate ability to problem-solve complex coding issues
• Experience : Experience with Medicare and Medicaid coding guidelines
• Skills : Strong data entry and attention to detail with ability to manage multiple tasks in a fast-paced setting
• Technology : Intermediate experience with Microsoft Word, Excel, Outlook, and Teams

Preferred Qualifications

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 attach your resume to your application (PDF or Word format) and submit in English.

Travel

Travel : While this is a remote position, occasional travel to Humana\'s offices for training or meetings may be required.

Compensation

Scheduled Weekly Hours : 40

Pay Range : $36,200 - $49,400 per year

Benefits

Humana offers competitive benefits including medical, dental and vision benefits, 401(k), time off, disability, life insurance, and 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.

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 to employ and advance individuals with disability or protected veteran status, in compliance with laws.

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