[Close] 

CEVM Coding Consultant

Company Name:
Humana
## Description
Role: Certified Coder Consultant
Assignment: PPS
Location: Louisville, KY or Green Bay, WI
As a Provider Network Operations consultant you will: be responsible for identifying new editing opportunities as it relates to claims cost management. provide strategic leadership and consultation services for the PNO area. You will complete analyses and prepare reports while interacting and building partnerships with Humana''s code editing, communications, and information technology teams.
Act as a liaison between multiple business partners to identify and resolve problems and concerns
Review vendor proposal for appropriate coding principals
Proactive research of CMS and other guidelines/references for new opportunities
Develop editing proposals and share with operational partners
## Qualifications
Role Essentials:
Current coding experience (or a very recent), where the majority of percentage of work is with coding and a broad scope of work (diagnosis codes, procedure codes, etc).
Coding certification (Industry-recognized coding certification from PHIA, AAPC and/or AHIMA. Apprentice status will not be considered.)
Extensive knowledge of medical claims processing and are familiar with ICD, CPT, HCPCS
Ability to track and trend data and use those findings to make recommendation
Basic proficiency with MS Office (Excel and Word)
Strong written and verbal communication skills
Strong organizational skills
Strong problem-solving skills
Possess self-drive and strong initiative
Role Desirables:
Experience with Medicare line of business
ICD-10 training/certification
Claims processing knowledge
BS in healthcare
Reporting Relationship: This role will report to a Business Consultant
Schedule: Full-time
Primary Location: US-KY-Louisville
Other Locations: US-WI-Green Bay
Role: Provider Network Operations
Req ID: 124924
Work Environment Type: Office

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.