Become a part of our caring community The Payment Integrity Professional 2 leverages claims data, vendor platforms, and analytic tools to identify trends, perform root cause analysis, and develop mitigation strategies that support accurate payment outcomes. This role collaborates with internal stakeholders and external code edit vendors to support pre and post implementation code editing functions. The position contributes directly to cost reduction and improved payment accuracy through data driven insights and operational execution. Where you Come In The Payment Integrity Professional 2 leverages claims data, vendor platforms, and analytic tools to identify trends, perform root cause analysis, and develop mitigation strategies that support accurate payment outcomes. This role collaborates with internal stakeholders and external code edit vendors to support pre and post implementation code editing functions. The position contributes directly to cost reduction and improved payment accuracy through data driven insights and operational execution. Responsibilities - Analyze medical claims data to identify trends, anomalies, and performance patterns related to code editing and payment accuracy - Conduct root‑cause analysis on incorrect payment outcomes and develop actionable mitigation plans - Support the review, testing, implementation, and maintenance of code edits, using data to validate expected outcomes - Partner with internal stakeholders and external vendors to translate analytic findings into operational improvements - Investigate and resolve code edit stakeholder inquiries through data research, issue analysis, and evidence‑based recommendations - Monitor key performance metrics, identify operational risks, and proactively recommend improvements - Drive process optimization and contribute to successful day‑to‑day operations - Document findings, maintain reports, and communicate results to technical and non‑technical audiences 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 Required Qualifications – What it takes to Succeed - Strong analytical skills with the ability to interpret data and identify trends - Experience conducting root‑cause analysis and developing mitigation or corrective action plans - Ability to manage multiple priorities and shift tasks quickly based on urgency - Working knowledge of Microsoft Word, SharePoint, and Excel - Comfortable making decisions in a dynamic, fast‑changing environment - Advanced problem‑solving skills, including critical thinking and collaboration - Ability to work independently and in a team with minimal supervision - High attention to detail and accuracy - Strong written and verbal communication skills - Ability to work in a fast‑paced environment - Commitment to confidentiality, ethical practice, and professional integrity Preferred Qualifications - Experience using CAS - Experience with code edit tools such as: - Rialtic Provider Inquiries Tool - ClaimsXten Web UI - Cotiviti What If Tool (WIT) - Optum CES - Cotiviti Claims Inquiry Tool (CIT) - Nucleus - KnowledgeSource - Experience analyzing medical claims data and interpreting payment outcomes - Experience with Humana code edit processes - Experience working with internal stakeholders and external vendors - Familiarity with PowerPoint and OneNote - Experience with THOR rule creation and/or maintenance - Experience leading projects or process‑improvement initiatives - Prior experience in Claims Administration and Payment Integrity (CAPI/CCM) Additional Information - How we Value You • Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parent Leave Work at Home Requirements • To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: · 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 HireVue to enhance our hiring and decision-making ability. HireVue 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. 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: 04-15-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ 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.

Role Description This position exists to provide accurate and timely clinical data for billing and optimal reimbursement, quality assessment, comparative databases, physician profiling, and administrative purposes. This position is responsible for, but not limited to: - Physician coding - Outpatient facility coding - Rectifying pre-bill coding related edits and coding related denials Utilizing coding guidelines, payer portals, and policies for optimal reimbursement. Processing charge corrections, write-offs, and patient balance transfers. Meeting established productivity and quality goals. Qualifications - Requires High School Diploma or equivalent. - RHIA, RHIT, CCS, CCS-P, COC, or CPC credential required. - Acceptable credentials or experience may vary depending on type of role (physician coding, facility coding, pre-bill coding edits). - Requires ability to read, understand and interpret medical records and other treatment documentation. - Requires a high level of interpersonal, problem solving, and analytic skills. - Requires the ability to establish and maintain collaborative working relationships with others. - Requires effective written and verbal communication skills. - Requires strong attention to detail, problem solving and critical thinking skills. - Requires ability to work with and maintain confidential information. Company Description Indiana University Health has nearly 40,000 team members, including more than 3,600 physicians and 1,200 advanced practice providers, and we’re home to the largest nursing network in Indiana with more than 9,000 nursing team members at over 800 sites of care. - IU Health is ranked No. 1 in Indiana by U.S. News & World Report. - Riley Children's Health is ranked among the top children's hospitals in the country by U.S. News & World Report. - A unique partnership with the Indiana University School of Medicine – one of the nation’s largest medical schools – gives patients access to groundbreaking research and innovative treatments. - 15 hospitals, including seven with Magnet designation and eight with Pathways to Excellence designation. - Personal and professional growth is a top priority, with access to diverse opportunities for learning and development. - Invested in the lives of Hoosiers, leading the transformation of healthcare to make Indiana one of the nation’s healthiest states. - Indiana’s most comprehensive health system, serving Hoosiers across the state.

Role Description We are seeking detail-oriented, compassionate, and client-focused professionals to assist seniors and eligible individuals in navigating the complex Medicare system. We are looking for an efficient medical billing clerk to prepare invoices and manage patient accounts. - Managing patient accounts and preparing invoices. - Inputting patient information and maintaining up-to-date records of patient data using computer software. - Ensuring that the patients receive the accounts. - Performing administrative tasks such as answering phone calls and responding to emails. - Acquiring and recording medical aid details from patients and liaising with the medical aid company to obtain authorization on payments owed by patients. - Following up with patients on accounts that are late as well as those which are seriously overdue. - Following work procedures methodically while ensuring compliance with the rules and regulations of the hospital or clinic as well as state and federal laws. - Improving job knowledge and skills by networking and staying abreast of medical service rates in order to ensure up-to-date billing. - Ensuring that patient records, accounts, and payments are meticulously handled. - Keeping all patient records confidential. Qualifications - A high school diploma or GED. - At least 2 years of administrative experience in a medical or healthcare setting. - Associate's degree in accounting, business, or economics may be preferred. - Basic mathematical skills. - Excellent communication skills to deal with medical insurance companies and to explain financial matters to patients and staff. - Above-average organizational skills to be able to locate files or patient records speedily. - Attention to detail to maintain patient records proficiently and to check that the accounts have been entered accurately. - The ability to process cash or credit card payments. - Proficiency in account data input to prepare statements for patients. - Knowledge of medical coding procedures.

Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: Coding-Professional and Outpatient facility Coding Job Summary: JOB SUMMARY Reviews, accurately assigns, and abstracts diagnostic and procedural codes to encounters using designated coding classification independently. Supports on-going training and development of staff. . KEY RESPONSIBILITIES • Organizes and prioritizes complex coding work to ensure compliance with regulatory requirements and hospital targets. • Assigns the most appropriate diagnosis and procedures to reflect the utilization of resources during the patient encounter. • Recognizes documentation clarification opportunities to ensure it supports all codes and designation assignments. Initiates coding queries or tasks. • Serves as a clinical coding subject matter expert. • The responsibilities listed are a general overview of the position and additional duties may be assigned. TECHNICAL CAPABILITIES • Medical Coding (Advanced): The transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. • Critical Thinking (Advanced): The objective analysis and evaluation of an issue in order to form a judgment. • Medical Terminology & Documentation (Advanced): The ability to comprehend medical terminology and documentation in an office, or surgical setting. • Compliance (Advanced): Understanding the rules, regulations, sanctions and other statutory requirements, guidelines and instructions relating to governing bodies and organizations, both internally and externally. Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more. At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose. Core Accountabilities: Organizational Impact: Independently delivers on objectives with understanding of how they impact the results of own area/team and other related teams. Problem Solving/ Complexity of work: Utilizes multiple sources of data to analyze and resolve complex problems; may take a new perspective on existing solution. Breadth of Knowledge: Has advanced knowledge within a professional area and basic knowledge across related areas. Team Interaction: Acts as a "go-to" resource for colleagues with less experience; may lead small project teams. Core Capabilities : Supporting Colleagues: - Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas. - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships. - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services: - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them. - Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions. - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly. - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure. - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area. - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation: - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches. - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges. - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements. Position Qualifications: Responsibilities: Certifications: LIC-Licensed Discipline Specific - Licensure-Others Work Experience: Relevant Work Experience Experience Level: 4 years Education: High School Diploma or GED Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.