Become a part of our caring community and help us put health first Code Edit Disputes team reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery. The Medical Coding Coordinator performs advanced administrative, operational, and customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. Where you Come In The Medical Coding Coordinator extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Decisions typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience and depth of knowledge of administrative processes and organizational knowledge. This is a remote position from anywhere in the US. What Humana Offers We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. 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: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Required Qualifications - Coding Certification required: AAPC CPC (no Apprentice) - 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 Microsoft Word and Excel, Outlook, and Teams ​ Preferred Qualifications - Bachelor's Degree - 5 or more years of experience as a Certified Medical Coder - CPMA certification - 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 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. $48,300 - $65,900 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.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Alignment Health is seeking a bilingual Spanish care coordinator to join the remote Care Anywhere team (must be located in California). The Care Coordinator works in collaboration with the RN Case Manager as part of the interdisciplinary team. The Care Coordinator supports members with closing care gaps and addressing care coordination needs as directed by the RN Case Manager. As part of the Case Management team is responsible for the health care management and coordination of care for members with complex and chronic care needs. The Care Coordinator is responsible for CM Coordinator functions for the members enrolled in Case Management. Schedule: Mondays - Fridays - Option 1: 8:00 AM - 5:00 PM Pacific Time (with 1-hour lunch) - Option 2: 8:30 AM - 5:30 PM Pacific Time (with a 30- minute lunch) GENERAL DUTIES / RESPONSIBILITIES: 1. Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc 2. Creates cases, tasks, and completes documentation in the Case Management module for all Hospital and SNF discharges 3. Complies with tasks assigned by nurse and, as appropriate and documents accordingly 4. Works as a team with the Case Manager to engage and manage a panel of members 5. Manages new alerts and updates Case Manager of changes in condition, admission, discharge, or new diagnosis 6. Establishes relationships with members, earns their trust and acts as patient advocate 7. Escalates concerns to nurse if members appear to be non-compliant or there appears to be a change in condition 8. Assists with outreach activities to members in all levels of Case Management Programs 9. Assists with maintaining and updating member’s records 10. Assists with mailing or faxing correspondence to members, PCP’s, and/or Specialists 11. Requests and uploads medical records from PCP’s, Specialists, Hospitals, etc., as needed 12. Meets specific deadlines (responds to various workloads by assigning task priorities according to department policies, standards and needs) 13. Maintains confidentiality of information between and among health care professionals 14. Other duties as assigned by CM Supervisor, Manager or Director of Care Management Job Requirements: Experience: • Required: Minimum 1 year experience working in Health Care such as Health Plan, Medical office, IPA, MSO. Minimum 1 year experience assisting members / patients with authorizations, scheduling appointments, identification of resources, etc. • Preferred: Education: • Required: High School Diploma or GED. Bachelor's degree or four years additional experience in lieu of education. • Preferred: MBA Training: • Required: • Preferred: Medical Assistant training, Medical Terminology training. Specialized Skills: • Required: - Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills. - Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. - Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. - Knowledge of Managed Care Plans - Knowledge of Medi-Cal - Basic Computer Skills, 35 WPM (Microsoft Outlook, excel, word) - Mathematical Skills: Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance. - Reasoning Skills: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. - Bilingual English / Spanish Licensure: • Required: None • Preferred: Medical Assistant Certificate, Medical Terminology Certificate Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. 2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $41,472.00 - $62,208.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation. *DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve – we care. What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow’s health today, we want to hear from you. At Biologics by McKesson, our mission is to simplify access to medication and deliver personalized care that helps patients achieve the best-possible outcomes — one patient, one partner, one therapy at time. Position Description As a Cell and Gene Insurance Reimbursement Specialist, you will have the opportunity to make a significant impact on patients' access to life-changing therapies, while navigating the complexities of insurance reimbursement. If you are passionate about the intersection of healthcare and insurance and are driven to improve patient outcomes, we invite you to apply for this exciting role. We are seeking a highly skilled and motivated individual to join our team as a Cell and Gene Insurance Reimbursement Specialist. In this role, you will be responsible for supporting the reimbursement process for cell and gene therapies, ensuring that insurance claims are accurately processed and reimbursed in a timely manner. As a specialist in this emerging field, you will play a critical role in ensuring patients can access innovative treatments while navigating complex insurance coverage and reimbursement processes. Key Responsibilities    - Insurance Verification: Verify patients' insurance coverage and benefits for cell and gene therapies, including pre-authorization requirements, limitations, and exclusions. Collaborate with healthcare providers, patients, market access, and insurance companies to ensure accurate and timely reimbursement for cell and gene therapies. - Appeals and Denials: Work in conjunction with clinical case managers to manage appeals and denials related to authorizations and insurance claims for cell and gene therapies, working closely with healthcare providers and insurance companies to resolve issues. - Documentation and Reporting: Maintain detailed records of insurance reimbursement activities, including status, reimbursement amounts, and any issues encountered during the process. Generate reports as needed. - Compliance and Regulations: Stay up to date with evolving insurance regulations and policies related to cell and gene therapies, ensuring compliance with all relevant guidelines. - Patient Support: Provide guidance and support to patients and their families regarding insurance coverage, reimbursement options, and financial assistance programs. - Collaboration: Collaborate with cross-functional teams, including healthcare providers, market access, billing department, and patient advocacy groups, to streamline reimbursement processes and improve patient access to cell and gene therapies. Minimum Requirement - Typically requires 5+ years of related experience. Education - Associate degree in healthcare administration, business, or a related field and/or relevant certifications or training in medical billing and coding, health insurance, or reimbursement processes are preferred. Critical Skills - 5+ years’ experience within specialty pharmacy, rare disease, hospital billing, infusion billing, or other relevant industry services including benefit verification, prior authorizations, medical billing, insurance reimbursement, or a related services. - Experience in the specialty healthcare or pharmaceutical segment with understanding of healthcare continuum and relationship between manufacturers, patients, providers, and payers - Strong understanding of health insurance coverage and reimbursement processes, including knowledge of medical coding and billing practices. Familiarity with cell and gene therapies and the associated reimbursement landscape is a plus. - Knowledge of applicable healthcare laws and regulations, including HIPAA, Medicare, and Medicaid guidelines. - Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint Additional Knowledge and Skills - Experience specifically related to cell and gene therapies is highly desirable. - Strong prioritization, time management and project management skills - Exceptional written and verbal communication skills, along with collaboration skills and ability to influence others; ability to build credible relationships across multi-business units. - Excellent verbal and written communication skills, with the ability to effectively communicate with patients, healthcare providers, and insurance companies. - Ability to work effectively in a team-oriented environment, collaborating with colleagues to achieve common goals. - Ability to manage complex issues, function independently, demonstrate flexibility, as well as the ability to work effectively with remote internal and external teams. - Strong analytical and problem-solving skills, with the ability to identify and resolve issues related to insurance reimbursement. - Critical thinking, analytical, research, and problem-solving skills Travel 20% travel required. We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, please click here. Our Base Pay Range for this position $19.36 - $32.26 McKesson has become aware of online recruiting-related scams in which individuals who are not affiliated with or authorized by McKesson are using McKesson’s (or affiliated entities, like CoverMyMeds or RxCrossroads) name in fraudulent emails, job postings or social media messages. In light of these scams, please bear the following in mind: McKesson Talent Advisors will never solicit money or credit card information in connection with a McKesson job application. McKesson Talent Advisors do not communicate with candidates via online chatrooms or using email accounts such as Gmail or Hotmail. Note that McKesson does rely on a virtual assistant (Gia) for certain recruiting-related communications with candidates. McKesson job postings are posted on our career site: careers.mckesson.com. McKesson is an Equal Opportunity Employer McKesson provides equal employment opportunities to applicants and employees, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age, genetic information, or any other legally protected category. For additional information on McKesson’s full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page. McKesson welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in all aspects of the selection process. If you require accommodation please contact us by sending an email to Disability_Accommodation@McKesson.com. Join us at McKesson!

Employment Type: Full timeShift: Description: Monday-Friday 8:30 a.m.-5pm No Weekends w/Holiday Rotations Position Purpose: The Authorization Specialist is responsible and accountable for the processing of all THAH authorization documentation meeting HCFA/MCC/JCAHO regulations and guidelines. Primary responsibilities include processing all frontend documentation needed to meet third party payer authorization deadlines assuring accurate billing. In addition, monitors all accounts for ongoing authorization needs to ensure optimal reimbursement and compliance per agency policy. This position works closely with the THAH insurance team and THAH Collection analysts in the tracking of authorizations and resolution of problematic billing issues. Monitors pending authorizations report and collaborates with both the clinical and revenue cycle team to review and resolve pending claims to ensure timely payment. Duties may be accomplished in a remote work environment. What You Will Do: - Prepares and enters data into the appropriate software assuring the accuracy of the regulated client account following all regulations placed on the homecare agency. Ensures that input of information is accurate, and authorization is received timely for the submission of claims. Responds to all system issues by preparing documentation for the resolution center. Timely follow up on pending authorizations to ensure payment of claims. - Generates all authorization documentation needed to bill in a timely manner assuring industry standards are met. Monitors and processes the Subsequent Authorizations workflow and reports daily to assure timely and clean billing. - Utilizing the CQI Process Improvement technique, responsible for implementing and monitoring changes to processes to ensure continued integrity of client accounts. Collaborates with the Intake Department to identify processes for improvement ensuring the accuracy of the authorization process. - Provides statistical feedback regarding the status of unbilled claims due to authorizations to THAH Revenue team on a weekly basis or as defined by policy. - Interfaces with THAH to resolve problems related to the processing of bills/claims. Investigates client accounts and provides any additional documentation required. - Seeks assistance of Clinical Team Leaders and/or Revenue Cycle Leaders with clinical data entry and/or billing problems. - Coordinates the flow of billing related paperwork between the branch and THAH Service Center. Works with the branch and THAH colleagues to identify areas of improvement related to authorization workflow. Actively participates in all billing conference calls between the agency and THAH. - Acts independently and responsibly to perform duties on a consistent basis and in a timely manner. - Coordinates tracking system to monitor unbilled claims due to authorizations and utilizes appropriate monitoring reports available. - Acts as liaison between physician offices, THAH Service Center and the agency to assure timely billing with appropriate documentation. - Ensures that services provided support continuous quality improvement, customer-oriented focus, and quality client care outcomes. - The duties and responsibilities described are not a comprehensive list and additional tasks may be assigned from time to time, as the scope of the job may change as necessitated by business demands. Benefits: - Day 1 Benefits - Health, dental and vision insurance - Work Today Get Paid Tomorrow - Employee Referral Reward Program - Short and long-term disability - Tuition Reimbursement - Paid CEUs - 403b - Generous paid time off - Comprehensive orientation Minimum Qualifications: - The incumbent can articulate and demonstrate a commitment to the mission, vision, and values of Trinity Health and to inspire active support of these in others. - The preferred candidate will have a high school diploma or GED. - College business courses or an associate degree is preferred, or four to six years of experience in a medical billing office setting with a concentration on authorizations. - A strong knowledge of general business office functions, strong analytical and organizational skills and microcomputer usage is required. - Incumbent must possess the following: ability to meet strict deadlines with high level of accuracy, ability to prioritize multiple tasks in highly automated setting and possess strong interpersonal skills. - Ability to consistently demonstrate commitment to the mission and Organizational Code of Ethics and adhere to the Compliance. Apply Today!!!! Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.