Behavioral Health Outpatient Medical Coding Auditor
About The Position
Humana is seeking an experienced medical coding auditor for its PPI Coding Disputes Team. The role focuses on outpatient behavioral health coding disputes and operates in a result-oriented, metrics-driven environment. The auditor reports to the Manager and consults and collaborates with coding professionals within and across departments to ensure coding dispute outcomes meet standards for timeliness, compliance, and quality. The position reviews outpatient behavioral health coding disputes, applies expertise in CPT/HCPCS code assignments, and communicates dispute outcomes to providers professionally and concisely. The auditor manages competing priorities, collaborates with peers, and completes reviews on time while following appropriate coding guidelines and standard industry practices. This is a remote role, with occasional travel to Humana offices for training or meetings potentially required.
Requirements
- CPC or CCS certification.
- CPT/HCPCS auditing experience.
- At least 1 year of work experience reading and interpreting behavioral health claims.
- At least 3 years of experience performing behavioral health coding audits in health insurance and/or hospital settings, and working coding-related disputes and trending results.
- Working knowledge of Microsoft Office programs, including Word, PowerPoint, and Excel.
- Ability to work independently and determine an appropriate course of action.
- Excellent written and verbal communication skills.
- For work at home, a self-provided internet connection with a minimum download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable, or DSL is suggested. Satellite, cellular, and microwave connections require leadership approval.
- Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.
Nice To Haves
- Associate's degree or higher in Health Information Management (HIM).
- Experience in financial recovery.
- Experience in a fast-paced, metric-driven operational setting.
Responsibilities
- Review outpatient behavioral health coding disputes and determine appropriate coding outcomes using industry guidelines and best practices.
- Ensure accuracy and compliance of coding dispute reviews by adhering to applicable coding guidelines.
- Communicate dispute outcomes to providers in a professional and concise manner.
- Collaborate with coding professionals within and across departments and with peers.
- Manage multiple priorities and complete outpatient coding disputes in a timely manner.
- Support accountability for dispute outcomes related to timeliness, compliance, and quality.
- Work independently and determine an appropriate course of action.
Benefits
- Health benefits effective day one.
- Paid time off, holidays, volunteer time, and jury duty pay.
- Recognition pay.
- 401(k) retirement savings plan with employer match.
- Tuition assistance.
- Scholarships for eligible dependents.
- Parental and caregiver leave.
- Employee charity matching program.
- Network Resource Groups (NRGs).
- Career development opportunities.
- Medical, dental, and vision benefits.
- Short-term and long-term disability insurance.
- Life insurance.
- Bonus incentive plan based on company and/or individual performance.
- Bi-weekly internet expense payment for employees who live and work from home in California, Illinois, Montana, or South Dakota.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
