Certified Inpatient Medical Coding Auditor
About The Position
Humana, a Fortune 100 Company, is looking for an experienced and Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments. The Certified Inpatient 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 goal is to ensure the accuracy and integrity of hospital claim payments.
Requirements
- 4+ years of MSDRG coding auditing experience
- RHIA, RHIT or CCS Certification (must have held certification for at least 4 years)
- Experience performing inpatient coding audits in a health insurance or hospital setting
- Experience reading and interpreting claims
- Proficiency in gathering or referencing data within different systems simultaneously
Nice To Haves
- Experience in APDRG coding/auditing
- Experience in Financial Recovery
- Experience in a metric driven operational setting
Responsibilities
- Review inpatient medical records and claims to ensure accurate coding and reimbursement
- Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes
- Audit coding quality and identify opportunities for improvement
- Investigate and resolve provider disputes with a fair, fact-based approach
- Analyze complex clinical documentation and coding scenarios
- Collaborate with other teams to clarify coding and medical information
- Contribute to cost savings by improving payment accuracy and reducing errors
Benefits
- medical
- dental
- vision
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
