Medical Coding Auditor (Outpatient)

About the role

The 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. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

This is a remote, work-at-home position. While remote, occasional travel to Humana's offices for training or meetings may be required.

Responsibilities

• Extract clinical information from medical records and assign appropriate procedural terminology and medical codes.
• Interpret and apply outpatient coding conventions and standards.
• Exercise solid judgment and discretion in handling and disseminating information.
• Work independently, manage workload, and handle multiple priorities in a production-based environment.
• Protect member PHI / HIPAA information by working from a dedicated, interruption-free space.

Requirements

• CPC, COC, CCS, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience.
• Minimum of 2 years of outpatient medical record auditing experience, including knowledge of outpatient coding conventions and standards.
• Strong knowledge of NCD/LCDs, CMS Manual, NCCI Edits, and coding guidelines.
• Demonstrated ability to work independently and determine appropriate courses of action.
• Strong attention to detail, analytical, organizational, and time management skills.
• Strong written and verbal communication skills.
• Working knowledge of Microsoft Office Programs (Word, Excel).
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps for home internet; wireless, wired cable, or DSL connection suggested.
• Associates must start each workday between 6 AM–9 AM EST, regardless of home time zone.

Preferred Qualifications

• 5+ years prior coding experience.
• Minimum of 3 years' experience reading and interpreting claims.
• Outpatient facility auditing experience.
• 3M Coder software experience.
• CRM/SRO, Pareo, MOAT experience.
• Prior appeals and/or disputes auditing experience.
• Experience in Financial Recovery.
• Experience in a fast-paced, metric-driven operational setting.
• Advanced and/or Specialty Coding Certifications.

Schedule

• Full-time, 40 hours per week.
• Typical business hours are Monday–Friday, 8 hours/day, 5 days/week.
• Some flexibility may be possible after training completion, depending on business needs.

Pay

The starting base pay range for this full-time position is $59,300 – $80,900 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.
• Associates in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses.
• Humana provides telephone equipment for home or hybrid home/office associates to meet business requirements.