Inpatient Medical Coding Auditor
About The Position
The Inpatient Medical Coding Auditor extracts clinical information from medical records and assigns appropriate procedural terminology and medical codes, including ICD-10-CM and CPT, to patient records. The work involves moderately complex to complex issues requiring in-depth evaluation of variable factors. At Humana, this auditor reviews inpatient hospital claims for proper reimbursement and handles provider disputes in a results-oriented, metrics-driven environment. The role supports cost reduction by improving the accuracy of provider contract payments and ensuring correct claims payment and appropriate diagnosis-related group (DRG) assignments. It also includes analyzing, entering, and manipulating database information and responding to or clarifying internal requests for medical information. The auditor works with minimal direction, follows established guidelines and procedures, and makes decisions about their own work methods, including in occasionally ambiguous situations. This is a remote work-at-home position. Occasional travel to Humana offices for training or meetings may be required. Typical hours are Monday through Friday, eight hours per day, scheduled between 6 a.m. and 6 p.m.; some flexibility may be possible depending on business needs. The position is scheduled for 40 hours per week.
Requirements
- RHIA, RHIT, or CCS certification, with at least one of these qualifications held for four years.
- MS-DRG coding or auditing experience.
- Experience reading and interpreting claims.
- Experience performing inpatient coding reviews or audits in health insurance and/or hospital settings.
- Working knowledge of Microsoft Word, PowerPoint, and Excel.
- Strong attention to detail.
- Ability to work independently and determine an appropriate course of action.
- Ability to handle multiple priorities.
- Ability to maintain confidentiality.
- Excellent written and verbal communication skills.
- For remote work, self-provided internet service must meet at least 25 Mbps download and 10 Mbps upload speeds; a dedicated workspace without ongoing interruptions is required to protect member PHI/HIPAA information.
Nice To Haves
- Experience in APR DRG coding or auditing.
- Experience in financial recovery.
- Experience in a fast-paced, metric-driven operational setting.
Responsibilities
- Extract clinical information from medical records and assign appropriate medical codes, including ICD-10-CM and CPT.
- Review inpatient hospital claims for proper reimbursement.
- Handle provider disputes in a results-oriented, metrics-driven environment.
- Support cost reduction by increasing the accuracy of provider contract payments.
- Ensure correct claims payment and appropriate DRG assignments.
- Analyze, enter, and manipulate database information.
- Respond to or clarify internal requests for medical information.
- Make decisions about work methods, follow established guidelines and procedures, and seek guidance when needed.
Benefits
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Bonus incentive plan
- Bi-weekly internet expense payment for associates working from home in California, Illinois, Montana, or South Dakota
- Telephone equipment appropriate to the business requirements
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
