Inpatient Medical Coding Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Extract clinical data from medical records and assign the relevant procedural terminology and medical codes, including ICD-10-CM and CPT.

• Review inpatient hospital claims to ensure proper reimbursement.

• Address provider disputes in a results-oriented and metrics-driven environment.

• Enhance the accuracy of provider contract payments within payer systems.

• Ensure correct claims payments and appropriate DRG assignments.

• Analyze, input, and manipulate information within databases.

• Respond to and clarify internal inquiries regarding medical information.

• Implement department, segment, and organizational strategies and operational objectives.

• Make decisions on work methods, even in ambiguous situations.

• Adhere to established guidelines and procedures.

• Participate in occasional travel to Humana offices for training or meetings.

⛳️ Requirements

• RHIA, RHIT, or CCS Certification, maintained for a minimum of 4 years.

• Experience in MS-DRG coding/auditing.

• Proficient in reading and interpreting claims.

• Experience conducting inpatient coding reviews/audits in health insurance and/or hospital environments.

• Familiarity with Microsoft Office Programs including Word, PowerPoint, and Excel.

• Strong attention to detail.

• Ability to work independently and determine the appropriate course of action.

• Capability to manage multiple priorities.

• Ability to maintain confidentiality.

• Excellent written and verbal communication skills.

• Recommended minimum internet speed of 25 Mbps download and 10 Mbps upload; required 25 Mbps download and 10 Mbps upload for future work-at-home requirements.

• Capacity to work from a dedicated space free from ongoing interruptions to protect member PHI/HIPAA information.

• Preferred: Experience in APR DRG coding/auditing.

• Preferred: Experience in Financial Recovery.

• Preferred: Experience in a fast-paced, metrics-driven operational environment.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Internet expense reimbursement for associates working from home in California, Illinois, Montana, or South Dakota.

• Humana-provided telephone equipment for Home or Hybrid Home/Office associates.

• Remote/work-at-home arrangement.

• Flexible scheduling may be available depending on business needs.