[Hiring] Inpatient Medical Coding Auditor @Humana

Role Description

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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG).

The Inpatient Medical Coding Auditor contributes 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 (DRG) assignments.
• Analyzing, entering, and manipulating database.
• Responding to or clarifying internal requests for medical information.
• Understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Making decisions regarding own work methods, occasionally in ambiguous situations, and requiring minimal direction.
• Following established guidelines/procedures.

WORK STYLE: Remote/work at home. While 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, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs.

Qualifications

• RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years)
• MS-DRG coding/auditing experience
• Experience reading and interpreting claims
• Experience in performing inpatient coding reviews/audits in health insurance and/or hospital settings
• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Strong attention to detail
• Can work independently and determine appropriate course of action
• Ability to handle multiple priorities
• Capacity to maintain confidentiality
• Excellent communication skills both written and verbal

Preferred Qualifications

• Experience in APR DRG coding/auditing
• Experience in Financial Recovery
• Experience in a fast-paced, metric-driven operational setting

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 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 anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to the next round of interviews.

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.

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Application Deadline

09-30-2026