Inpatient Medical Coding Auditor

Description

The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM/ PCS) to patient records. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Where you Come In 
Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG) - Coding Disputes Team opportunity with Humana.
The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

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.  

This is a Remote anywhere in the US 40 hour per week role and the work hours will be 8 hours a day Monday to Friday 
 

               

Required Qualifications – What it takes to Succeed
•    RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years)
•    MS-DRG coding/ auditing experience
•    Minimum of 1 years' work experience reading and interpreting claims
•    Minimum of 3 years’ experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings
•    Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
•    Strong attention to detail
•    Can work independently and determine appropriate course 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

• According to Humana’s COVID-19 policy, vaccination and masking is required regardless of vaccination status (with exception for eating and drinking) for associates working in a clinical setting where patients receive care (e.g., pharmacy retail locations, clinics, home care). The policy only requires the primary series alone (first and second vaccine). Boosters are encouraged, but not required. Associates have the option to request an accommodation for medical, religious or other personal needs.

Preferred Qualifications
•    Associate's Degree or higher in Health Information Management (HIM)

•    Experience in APR DRG coding/ auditing
•    Experience in Financial Recovery
•    Experience in a fast paced, metric driven operational setting

Additional Information - How we Value You  
•    Benefits starting day 1 of employment 
•    Competitive 401k match  
•    Generous Paid Time Off accrual  
•    Tuition Reimbursement 
•    Parent Leave 
•    Go365 perks for well-being 

Work-At-Home Requirements

•            WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

•            A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. 

•            Satellite and Wireless Internet service is NOT allowed for this role.

•            A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format 
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
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.

 

Scheduled Weekly Hours

40