Medical Coding Auditor

The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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.

The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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.

As a Medical Coding Auditor for the Outpatient Facility/APC Coding Team you will:

• Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered

• Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Outpatient Facility coding

• Utilize encoders and various coding resources

• Perform CPT/HCPCS Procedure reviews

• Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed

• 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 guidelines, government regulation and protocols

• Complete appropriate system(s) entry regarding claim/encounter information

• Support and participate in process and quality improvement initiatives

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

Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Some flexibility might be possible, depending on business needs.

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

• Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures

• Strong knowledge of CPT/HCPCS coding

• Experience reading & coding from operative reports

• Chemotherapy and/or Therapeutic Infusion experience

• 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)

• 5+ years prior coding experience

• Outpatient facility auditing experience

• Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion,…