Become a part of our caring community and help us put health first The Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing code editing guidelines and data anomalies to ensure correct claim payment. The Payment Integrity Professional work assignments require in-depth research, cross departmental collaboration, independent determination of the appropriate course of action, and involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Payment Integrity Coding Professional monitors and analyzes Code Edit operational processes and performance metrics to identify inefficiencies and opportunities for improvement. Partners with internal business partners to support business initiatives, including identifying the root cause of challenges, designing solutions to the challenges, and implementing solutions. Builds and maintains strong internal working relationships at all levels of the organization and across the Enterprise; leverages these relationships in helping to drive innovation and effective operations for Humana. Engages in implementations and/or ad hoc projects, within assigned scope of responsibilities to understand requirements, to support and guide team members on priorities and help manage risks and escalations. Use your skills to make an impact WORK STYLE: Remote/Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Standard business hours are Monday - Friday, 8 hours/day, 5 days/week. Core business hours are 8AM - 5PM Eastern time. Required Qualifications - AAPC or AHIMA Coding Certification - CPC or CCS - Minimum 3 years post certification experience utilizing coding guidelines by reading and interpreting claims - Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct coding initiatives, national benchmarks, and industry standards - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate courses of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal - Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications - Bachelor's degree - Experience leading people, projects, and/or processes - Experience using the following systems: CAS and Code Edit vendor tools - Experience in a fast paced, metric driven operational setting Additional Information - 100% remote role - Standard business hours are Monday - Friday, 8 hours/day, 5 days/week. Core business hours are 8AM - 5PM Eastern time. Work at Home Requirements • 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 Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. 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. 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. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. 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. Application Deadline: 03-09-2026 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.

This position can be remote. Please review the approved remote states below. Remote Work Approved States: Arizona Florida Georgia Idaho Iowa South Dakota Texas South Carolina Wisconsin North Carolina Michigan *If your state is not listed, you must relocate to Montana or one of the approved states above to be eligible for this position. Position Summary: Responsible for reviewing and resolving post-billed coding-related denials and rejections for hospital and medical group claims to support accurate reimbursement and denial prevention. Applies expertise in International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) to validate denial rationale, determine root cause, and recommend corrective actions. Prepares, submits, and tracks payer appeals and reconsiderations within required timeframes while maintaining complete documentation. Collaborates with coding, billing, clinical, compliance, and information systems partners to reduce avoidable denials and provide education on coding best practices. Qualifications: Required - Associate’s Degree in Health Information Management, Business, or related field, or equivalent combination of education and experience may be considered. - Current coding certification: CCA, CPC, CCS, CCS-P, CPMA, RHIA, or RHIT. - Three (3) years’ experience in advanced hospital and professional (practice) coding. - Knowledge of ICD-10 diagnosis and procedure coding, CPT, HCPCS, modifiers, and coding guidelines. - Proficiency with Microsoft Office applications, including advanced Excel, Word, and PowerPoint skills. Preferred - Bachelor’s Degree in Health Information Management, Business, or related field. - Two (2) years’ experience in coding denial management, appeals, or related denial resolution work. - Certified Professional Medical Auditor (CPMA). - Experience with Epic and 3M. - Experience using payer portals, electronic work queues, and denial/appeals tracking tools. Essential Job Functions: In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements. - Reviews and triages post-billed coding denials, rejections, and coding-related billing edits for assigned professional and/or facility claim inventory. - Validates denial rationale using remittance advice/Explanation of Benefits (EOB), payer policies, coding guidelines, and applicable regulations. - Performs medical record review to confirm documentation support, code selection, modifier usage, and charge accuracy; identifies and initiates required corrections. - Coordinates charge and coding corrections and supports rebilling actions in accordance with established workflows and department standards. - Drafts, submits, and tracks first-level and second-level appeals/reconsiderations, ensuring compliance with payer requirements and timely filing deadlines. - Documents actions taken, supporting evidence, communications, and outcomes in the denial management system to maintain a complete audit trail. - Analyzes denial trends and root-cause categories; prepares routine and ad hoc reports and communicates findings to stakeholders. - Partners with coding, billing, clinical staff, patient access, information systems, and compliance to resolve complex denials and implement denial prevention strategies. - Develops and delivers education and presentations to providers and staff on denial drivers and coding best practices, including National Correct Coding Initiative (NCCI) edits. - Maintains working knowledge of payer medical review policies and regulatory guidance, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). Knowledge, Skills and Abilities - Demonstrates sound judgment, patience, and maintains a professional demeanor at all times - Exercises tact, discretion, sensitivity, and maintains confidentiality - Performs essential job functions successfully in a busy and stressful environment - Learns current and new computer applications and office equipment utilized at Bozeman Health - Strong interpersonal, verbal, and written communication skills - Analyzes, organizes, and prioritizes work while meeting multiple deadlines Schedule Requirements - This role requires regular and sustained attendance. - The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts. - On-call work may be required to respond promptly to organizational, patient, or employee needs. Physical Requirements - Lifting (Rarely – 30 pounds): Exerting force and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people. - Sit (Continuously): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain. - Stand (Occasionally): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain. - Walk (Occasionally): Walking and moving around within the work area requires good balance and coordination. - Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms. - Twist/Bend/Stoop/Kneel (Occasionally): Twisting, bending, stooping, and kneeling require flexibility and a wide range of motion in the spine and joints. - Reach Above Shoulder Level (Occasionally): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability. - Push/Pull (Occasionally): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward. - Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling. - Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials. - Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow. - Exposures (Rarely): Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases due to contact with patients in areas that may have contagious illnesses. *Frequency Key: Continuously (100% - 67% of the time), Repeatedly (66% - 33% of the time), Occasionally (32% - 4% of the time), Rarely (3% - 1% of the time), Never (0%). The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified. 77212200 HIM Production

🚨 Now Hiring: RN Case Manager – NJ Region 🚨 💻 Work from home + local field travel 💰 Salary: $75,000 - $85,000 annually 🎉 Quarterly Bonus Opportunities 📚 Free CEUs for licenses & certificates 💳 License & Certification Reimbursement We’re looking for an RN with a passion for case management to join our team! ✨ RN degree required ✨ National Certification preferred (CCM, CRC, COHN, CRRN) ✨ Workers’ Comp Case Management experience a plus 📍 Location Requirement Candidates must be based in one of these New Jersey areas: Denville, Parsippany, Morristown, and Whippany. ✅ Your Impact: You’ll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You’ll support patients/employees receiving benefits under insurance lines including Workers’ Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance. 👉 Apply today and make an impact in the community! Why Crawford? Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com. When you accept a job with Crawford, you become a part of the One Crawford family. Our total compensation plans provide each of our employees with far more than just a great salary - Pay and incentive plans that recognize performance excellence - Benefit programs that empower financial, physical, and mental wellness - Training programs that promote continuous learning and career progression while enhancing job performance - Sustainability programs that give back to the communities in which we live and work - A culture of respect, collaboration, entrepreneurial spirit and inclusion Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.

Service Desk Engineer needed for large well established California Bank (contract-to-hire) This Jobot Consulting Job is hosted by: Joseph Calabrese Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume. Salary: $25 - $27 per hour A bit about us: Service Desk Engineer needed for large well established California Bank Why join us? - Leverage the latest technologies - Strong while contracted benefits (M,D,V, and 401k) Upon Conversion: - Profit sharing contribution - Great PTO plan - Holiday bonus Job Details Job Details: Seeking a dynamic and skilled Service Desk Engineer to join our team on a permanent basis. The ideal candidate will be responsible for maintaining and improving our company's IT infrastructure, ensuring that our systems are always up-to-date, secure, and efficient. This role is critical to our business operations, as it ensures that our team has the tools and resources necessary to provide excellent service to our clients. Responsibilities: - Provide first-line IT support to all staff members, addressing any issues related to our software, hardware, or network. - Utilize Zendesk to manage and respond to IT support tickets in a timely and effective manner. - Implement ITSM best practices to ensure efficient and effective IT service management. - Maintain, upgrade, and troubleshoot Windows-based systems and servers. - Collaborate with the IT team to develop and implement IT strategies and systems that align with our business objectives. - Ensure the security of our IT systems, implementing necessary updates and safeguards to protect sensitive data. - Conduct regular audits and tests to identify any potential issues or opportunities for improvement. - Provide training and guidance to staff on new systems, software, and best practices for IT use. Qualifications: - A minimum of 2 years of experience in IT support or a related role. - Expertise in Zendesk, ITSM, and Windows. Experience with other similar platforms will also be considered. - A degree in Computer Science, Information Technology, or a related field is preferred. - Strong problem-solving skills and the ability to think on your feet. - Excellent communication skills, with the ability to explain complex IT concepts in a clear and understandable manner. - A commitment to staying up-to-date with the latest developments in IT and the mortgage industry. - A team-oriented mindset, with a willingness to collaborate and share knowledge with colleagues. - The ability to manage multiple tasks and priorities in a fast-paced, deadline-driven environment. Interested in hearing more? Easy Apply now by clicking the "Apply" button. Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions. Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance. Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy