Inpatient Medical Coding Auditor

Profile

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, CPT) 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 and appeals 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/ APDRG) - 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 and APR-DRG auditing experience

Minimum of 1 years' work experience reading and interpreting claims

Minimum of 3 years' experience in performing inpatient coding audits in health insurance and/or hospital settings and working coding-related disputes and trending results

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 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

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com