Inpatient Medical Coding Auditor

Humana

4d • $71,100 - $97,800 • Remote

About The Position

Humana is seeking an experienced, Remote Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. This role is crucial for ensuring accurate claims payment, appropriate diagnosis-related group assignments, and overall cost reduction by increasing the accuracy of provider contract payments in payer systems. The auditor will extract clinical information from medical records, assign appropriate medical codes (ICD-10-CM, ICD-10-PCS, CPT), and ensure the integrity of hospital claim payments. The work hours are Monday-Friday, 8 hours per day, 40 hours per week, scheduled between 6 AM-6 PM, with a potential shift to be discussed during the interview. Occasional travel to Humana's offices for training or meetings may be required.

Requirements

• Four or more 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
• Minimum download speed of 25 Mbps and an upload speed of 10 Mbps for internet service
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed