Inpatient Medical Coding Auditor (MSDRG)

Employment Type: Full-time Location Type: 100% Remote/Work at Home Scheduled Weekly Hours: 40

Position Overview

Become a part of our caring community and help us put health first. In this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop educational materials. This is a full-time, remote/work-from-home position.

The Inpatient Medical Coding Auditor extracts clinical information from medical records and assigns appropriate codes (e.g., ICD-10-CM, CPT). This role involves analyzing moderately to highly complex issues requiring in-depth evaluation of variable factors.

The Coding Quality Team is looking for an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider this role.

Do you love working on several different projects? Do you take pride in helping others and being flexible? Do you pay great attention to detail and have a passion for healthcare? Do you have a solid background in medical auditing, coding, and medical record review? If you answered YES to one or more of the above, you should strongly consider this role.

Responsibilities

• Conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus on DRG audits.
• Drive process improvement initiatives.
• Develop educational materials.

Required Qualifications

• 7+ years of DRG Coding
• 5 years of Quality Auditing
• Medical coding certification from AHIMA (RHIT, CCS, CICA, CHCA)
• Prior experience reading and coding from medical records.
• Strong critical thinking skills.
• Proficient in independently managing diverse priorities, adept at swiftly transitioning between tasks based on urgency and demand with minimal instruction.
• Demonstrated ability to work independently and manage workload.
• Exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence, and commitment to the profession.
• Excellent writing, editing, interpersonal, planning, teamwork, and communication skills.
• Proficient in MS Office applications including Word, Excel, Outlook, PowerPoint.
• Proven ability to work independently.

Work at Home Requirements

• Must be able to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
• A dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Preferred Qualifications

• CAS, MOATS and FR experience.
• Process improvement experience.
• Multi-Specialty Auditing experience.

What Humana Offers

• A remote opportunity.
• A Fortune 100 Company that values associate engagement & your well-being.
• Excellent professional development & continued education.

Interview Format

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 from you pertaining to your relevant skills and experience at a time that is convenient for you.