Inpatient Medical Coding Auditor

** Become a part of our caring community*
* Are you a detail-driven coding expert who enjoys solving complex clinical puzzles and making a measurable impact on payment accuracy and provider satisfaction? Humana, a Fortune 100 Company, is looking for an experienced, Remote medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments.

WORK HOURS are Monday-Friday, 8 hours per day, 40 hours per week, and are scheduled between 6AM-6PM. Potential shift to be discussed during the interview.

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 goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following:

+ Review inpatient medical records and claims to ensure accurate coding and reimbursement

+ Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes

+ Audit coding quality and identify opportunities for improvement

+ Investigate and resolve provider disputes with a fair, fact-based approach

+ Analyze complex clinical documentation and coding scenarios

+ Collaborate with other teams to clarify coding and medical information

+ Contribute to cost savings by improving payment accuracy and reducing errors

** Use your skills to make an impact*
* ** Required Qualifications*
* + Four or more years of MSDRG coding auditing experience

+ RHIA, RHIT or CCS Certification (must have held certification for at least 4 years)

+ Experience performing inpatient coding audits in a health insurance or hospital setting

+ Experience reading and interpreting claims

+ Proficiency in gathering or referencing data within different systems simultaneously

** Preferred Qualifications*
* + Experience in APDRG coding/auditing

+ Experience in Financial Recovery

+ Experience in a metric driven operational setting

** Work at Home Requirements*
* To ensure Home Office employees' ability to work effectively, the self-provided internet service of Home Office employees must meet the following criteria:

+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

+ Satellite, cellular and microwave connection can be used only if approved by leadership.

+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

** Interview Process*
* As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward, you will receive outreach from Hire Vue to complete a pre-screening.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

** Scheduled Weekly Hours*
* 40

** Pay Range*
* The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

** Description of Benefits*
*…