Medical Coding Auditor - Outpatient amp Surgical Specialty Coding Team-Remote in US

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Job Information
Humana
Medical Coding Auditor - Outpatient & Surgical Specialty Coding Team-Remote in US
in
Torrance
California
Description
The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guideline are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 CPT/ HCPCS code 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.
Responsibilities
Where you Come In
The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guideline are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 CPT/ HCPCS code 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.
As a Medical Coding Auditor for Clinical Audits with the Internal Audit Team you will:
Review medical documentation for clinical indicators to ensure specific diagnoses and/or procedures meet clinical criteria and correct coding guidelines
Utilize encoders and various coding resources
Perform CPT Procedure reviews
Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
Maintain current working knowledge of ICD-9, ICD-10 and CPT coding principles, government regulation, protocols
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.
Required Qualifications - What it takes to Succeed
RHIA, RHIT, CCS or CPC Certification with a minimum of 3 years post-certification experience
Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures
Minimum of 3 years post certification experience reading and interpreting claims
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
For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.
If progressed to offer, you will be required to:
Provide proof of full vaccination OR
Commit to weekly testing, following all CDC protocols, OR
Provide documentation for a medical or religious exemption consideration.
This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.
Preferred Qualifications:
High School Diploma, GED or job related certification
Bachelor's Degree- Healthcare Related
Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures for Physicians
Experience with the Claims Life Cycle
Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology
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
Screen/Interview Information
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.
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
#ThriveTogether #WorkAtHome
Scheduled Weekly Hours
40

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