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The Inpatient Medical Coding Auditor extracts clinical information from various medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. This role involves moderately complex to complex issues requiring in-depth evaluation of data.
Humana is seeking an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement and manage provider disputes in a results-driven environment. This remote position may require occasional travel to Humana offices for training or meetings.
The auditor contributes to cost reduction by improving accuracy of provider contract payments, ensuring correct claims payment, and appropriate diagnosis related group (DRG) assignments. Works with databases, responds to internal requests for medical information, and operates with minimal supervision following established procedures.
Work Hours: Monday to Friday, 8 hours per day, between 6AM-6PM, with some flexibility.
Required Qualifications:
- RHIA, RHIT, or CCS Certification held for at least 4 years
- MS-DRG coding/auditing experience
- Experience reading and interpreting claims
- Experience performing inpatient coding reviews/audits in health insurance or hospital settings
- Proficiency with Microsoft Word, PowerPoint, and Excel
- Strong attention to detail
- Ability to work independently, handle multiple priorities, maintain confidentiality
- Excellent written and verbal communication skills
Preferred Qualifications:
- Experience in APR DRG coding/auditing
- Experience in financial recovery
- Experience in fast-paced, metric-driven operational settings
Work From Home Requirements:
- Minimum 25 Mbps download and 10 Mbps upload speed
- Wired, wireless cable, or DSL connection preferred
- Satellite, cellular, microwave connection requires leadership approval
- Residents in CA, IL, MT, or SD may receive bi-weekly internet expense reimbursement
- Dedicated, interruption-free work space to protect PHI/HIPAA
Interview Format:
- Pre-recorded voice or SMS text interviews via Hire Vue technology lasting 5-15 minutes
Scheduled Weekly Hours: 40
This position offers a bonus incentive plan based on company or individual performance.
About Humana: Humana Inc. is a leading U.S. healthcare company focused on delivering care and service to improve quality of life for people with Medicare and Medicaid, families, individuals, military personnel, and communities. Learn more at Humana.com and CenterWell.com.
Equal Opportunity Employer committed to diversity and non-discrimination.
- RHIA, RHIT, or CCS Certification held for at least 4 years
- MS-DRG coding/auditing experience
- Experience reading and interpreting claims
- Experience performing inpatient coding reviews/audits in health insurance or hospital settings
- Proficiency with Microsoft Office (Word, PowerPoint, Excel)
- Strong attention to detail
- Ability to work independently and manage multiple priorities
- Ability to maintain confidentiality
- Excellent written and verbal communication skills
Preferred:
- APR DRG coding/auditing experience
- Financial recovery experience
- Experience in fast-paced, metric-driven work environment
Humana offers competitive benefits including medical, dental, and vision coverage; 401(k) retirement savings plan; paid time off including holidays and parental leave; short-term and long-term disability; life insurance; and programs supporting whole-person well-being.
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$71,100 - $97,800
Remote work allowed
Yes
Posted
3 weeks ago