Inpatient Medical Coding Auditor

Humana

10d • $71,100 - $97,800 • Remote

About The Position

The Inpatient Medical Coding Auditor extracts clinical information from medical records and assigns appropriate procedural terminology and medical codes, such as ICD-10-CM and CPT, to patient records. The role reviews inpatient hospital claims for proper reimbursement, handles provider disputes, and helps reduce costs by improving the accuracy of provider contract payments and ensuring correct claims payments and appropriate diagnosis-related group (DRG) assignments. The work involves moderately complex to complex issues requiring in-depth evaluation of variable factors.

The auditor analyzes, enters, and manipulates databases and responds to or clarifies internal requests for medical information. The role requires understanding departmental, segment, and organizational strategy and operating objectives and their relationship to other areas. The auditor makes decisions about their own work methods, sometimes in ambiguous situations, follows established guidelines and procedures, and works with minimal direction while receiving guidance when needed.

This is a remote work-at-home position. Occasional travel to Humana offices for training or meetings may be required. Typical work 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. Home workers need a dedicated, interruption-free workspace to protect member PHI/HIPAA information and must meet the stated internet service requirements.

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.
• Self-provided home internet service meeting the stated minimum speed requirements: 25 Mbps download and 10 Mbps upload.
• Ability to work from a dedicated space without ongoing interruptions 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 procedural terminology and 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.
• Help reduce costs by improving the accuracy of provider contract payments in payer systems.
• Ensure correct claims payment and appropriate DRG assignments.
• Analyze, enter, and manipulate databases.
• Respond to or clarify internal requests for medical information.
• Make decisions about work methods, follow established guidelines and procedures, and work with minimal direction.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and company and personal holidays.
• Paid parental and caregiver leave.
• Short-term and long-term disability coverage.
• Life insurance.
• Bonus incentive plan based on company and/or individual performance.
• For associates who live and work from home in California, Illinois, Montana, or South Dakota, a bi-weekly payment for internet expenses.
• Telephone equipment provided to home or hybrid home/office associates as appropriate to the position's business requirements.

What This Job Offers

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