Medical Coding Auditor

Humana

1d • Remote

About The Position

The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters and manipulates the claim in the respective database. Responds to or clarifies internal requests for medical information. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Review medical documentation for clinical indicators to ensure trauma activations meet clinical criteria and correct coding guidelines Utilize encoders and various coding resources Perform CPT Procedure reviews Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information Maintain current working knowledge of ICD-10 and CPT coding principles, government regulation, protocols

Requirements

• RHIA, RHIT, CCS Certification
• Minimum of 3+ years post certification experience with acute inpatient coding
• Experience reading & coding from trauma activations
• Strong knowledge of NCD/LCDs, CMS Manual, NCCI Edits, and coding guidelines
• Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities
• Comfortable working in a production-based work environment
• Ability to work independently and manage workload

Nice To Haves

• Experience with coding/auditing Professional Inpatient Claims
• Experience with the Claims Life Cycle

Responsibilities

• Reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met.
• Confirms correct CPT coding assignments.
• Analyzes, enters and manipulates the claim in the respective database.
• Responds to or clarifies internal requests for medical information.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.
• Review medical documentation for clinical indicators to ensure trauma activations meet clinical criteria and correct coding guidelines.
• Utilize encoders and various coding resources.
• Perform CPT Procedure reviews.
• Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information.
• Maintain current working knowledge of ICD-10 and CPT coding principles, government regulation, protocols.

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

What This Job Offers

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