Certified Inpatient Medical Coding Auditor

Become a part of our caring community. Your expertise will directly contribute 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 assignments.

About the role

The Certified 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 goal is to ensure the accuracy and integrity of hospital claim payments.

Responsibilities

• Review inpatient medical records and claims to ensure accurate coding and reimbursement
• Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes
• Audit coding quality and identify opportunities for improvement
• Investigate and resolve provider disputes with a fair, fact-based approach
• Analyze complex clinical documentation and coding scenarios
• Collaborate with other teams to clarify coding and medical information
• Contribute to cost savings by improving payment accuracy and reducing errors

Requirements

• 4+ years of MSDRG coding auditing experience
• RHIA, RHIT or CCS Certification (must have held certification for at least 4 years)
• Experience performing inpatient coding audits in a health insurance or hospital setting
• Experience reading and interpreting claims
• Proficiency in gathering or referencing data within different systems simultaneously

Preferred Qualifications

• Experience in APDRG coding/auditing
• Experience in Financial Recovery
• Experience in a metric driven operational setting

Schedule

WORK HOURS are Monday-Friday, 8 hours per day, 40 hours per week, and are scheduled between 6AM-6PM. Potential shift to be discussed during the interview.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary.

Travel

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

Pay

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

Humana offers competitive benefits that support whole-person well-being. Among our benefits, Humana provides:

• 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