Inpatient Medical Coding Auditor

Humana

1d • Remote

About The Position

The 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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. This is a remote/work at home position for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance. The Inpatient 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 diagnosis related group (DRG) 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.

Requirements

• RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years)
• MS-DRG coding/auditing experience
• Experience reading and interpreting claims
• Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings
• 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
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership

Nice To Haves

• Experience in APR DRG coding/auditing
• Experience in Financial Recovery
• Experience in a fast paced, metric driven operational setting

Responsibilities

• 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.
• Reviews inpatient hospital claims for proper reimbursement.
• Handles provider disputes in a result-oriented and metrics-driven environment.
• Contributes to overall cost reduction by increasing the accuracy of provider contract payments in payer systems.
• Ensures correct claims payment and appropriate diagnosis related group (DRG) 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.

Benefits

• medical
• dental
• vision benefits
• 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
• bi-weekly payment for internet expense (for associates in California, Illinois, Montana, or South Dakota)
• telephone equipment appropriate to meet the business requirements for their position/job

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees