HIM Clinical Data Quality Auditor and Educator
Virta HealthSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must possess 7+ years of DRG Coding experience, 5 years of Quality Auditing experience, and a medical coding certification from AHIMA (RHIT, CCS, CICA, or CHCA). Prior experience reading and coding from medical records is required, along with strong critical thinking skills and proficiency in independently managing diverse priorities. Demonstrated ability to work independently and a commitment to professionalism, flexibility, dependability, and excellence are also necessary. Excellent writing, editing, interpersonal, planning, teamwork, and communication skills, along with proficiency in MS Office applications, are required. A high-speed DSL or cable modem with a minimum standard speed of 10x1 (10mbps download x 1mbps upload) is needed for a home office, and a dedicated space free from interruptions is essential to protect member PHI/HIPAA information.
Responsibilities
The Inpatient DRG Quality Auditor will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus on DRG audits. They will also drive process improvement initiatives, develop educational materials, handle provider disputes in a result-oriented and metrics-driven environment, and analyze moderately to highly complex issues requiring in-depth evaluation of variable factors. The role involves reading and coding medical records, assigning appropriate codes (e.g., ICD-10-CM, CPT), and providing advice on HR-related risk mitigation strategies.
Skills
Medical coding
ICD-10-CM
CPT
Medical record review
Healthcare auditing
Process improvement
Educational material development
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Key Metrics
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees