Senior Medical Coding Professional, Inpatient

About the role

The Senior Medical Coding Professional, Inpatient supports payment integrity initiatives by reviewing inpatient claims for coding accuracy, DRG assignment, and compliance with official guidelines. You will report to the Manager, Payment Integrity.

Responsibilities

• Review inpatient records for coding accuracy and DRG validation
• Identify anomalies for audit targeting
• Apply ICD-10-CM/PCS coding guidelines and DRG logic
• Audit and document findings
• Recommend adjustments, recoveries, or provider education
• Collaborate with clinical reviewers and data analysts

Requirements

• Use your skills to make an impact
• Required: RHIA, RHIT, CCS, or CIC
• 5+ years inpatient coding experience
• Audit or validation experience
• Strong DRG knowledge (MS-DRG/APR-DRG)
• Understanding of CDI and severity of illness (SOI/ROM) concepts

Preferred Qualifications

• 3M Coding software experience
• Bachelor’s degree
• Previous leadership experience

Additional Information

Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: 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. 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.

Hiring Process

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. 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 and many other opportunities.