[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 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.
• Contribute to overall cost reduction by increasing the accuracy of provider contract payments.
• Ensure correct claims payment and appropriate diagnosis related group (DRG) assignments.
• Analyze, enter, and manipulate database.
• Respond to or clarify internal requests for medical information.
• Understand department, segment, and organizational strategy and operating objectives.
• Make decisions regarding own work methods with minimal direction.

WORK STYLE:

• Remote/work at home with occasional travel to Humana's offices for training or meetings.

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 (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.
• Ability to work independently and determine appropriate course of action.
• Ability to handle multiple priorities.
• Capacity to maintain confidentiality.
• Excellent communication skills both written and verbal.

Requirements

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

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 and many other opportunities.

Additional Information

• 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.

• 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.
• Expect the pre-recorded interview to take approximately 10-15 minutes.
• Expect the SMS Text interview to last anywhere from 5-10 minutes.

Scheduled Weekly Hours

• 40 hours per week.

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 based on company and/or individual performance.