Medical Coding Auditor; Outpatient

Position: Medical Coding Auditor (Outpatient)
Location: Dover

Become a part of our caring community
The 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 Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The 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 Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Use your skills to make an impact
Additional

Job Description

WORK STYLE:
Remote, work le this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

WORK HOURS:

Typical business hours are Monday-Friday, 8 hours/day, 5 days/week-- some flexibility might be possible, once training is complete and depending on business needs.

Associates are expected to start each workday between 6AM-9AM EST, regardless of their home time zone.

Required Qualifications – What it takes to Succeed

CPC, COC, CCS, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience

Minimum of 2 years of outpatient medical record auditing experience including knowledge of outpatient coding conventions and standards

Strong knowledge of NCD/LCDs, CMS Manual, NCCI Edits, and coding guidelines

Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information

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

Strong written and verbal communication skills; strong analytical, organizational and time management skills

Working knowledge of Microsoft Office Programs (Word, Excel)

Preferred Qualifications

5+ years prior coding experience

Minimum of 3 years' experience reading and interpreting claims

Outpatient facility auditing experience

3M Coder software experience

CRM/SRO, Pareo, MOAT experience

Prior appeals and/or disputes auditing experience

Experience in Financial Recovery

Experience in a fast paced, metric driven operational setting

Advanced and/or Specialty Coding Certifications

Work at Home Requirements
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

Associates 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 associates 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 Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision‑making ability. Hire Vue (formerly Modern Hire 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 from your application prescreen, you will receive correspondence inviting you to participate in a pre‑recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre‑recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10‑15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last…