[Remote] Inpatient Medical Coding Auditor at Humana

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must possess an RHIA, RHIT, or CCS certification held for at least 4 years, along with MS-DRG coding/auditing experience. They should have experience reading and interpreting claims, performing inpatient coding reviews/audits in health insurance and/or hospital settings, and a working knowledge of Microsoft Office Programs (Word, PowerPoint, Excel). Strong attention to detail, the ability to work independently and handle multiple priorities, and capacity to maintain confidentiality are essential. Preferred qualifications include experience in APR DRG coding/auditing, financial recovery, and working in a fast-paced, metric-driven operational setting. Additionally, candidates must meet specific work-at-home requirements, including internet speed, and have a dedicated, interruption-free workspace.

Responsibilities

The Inpatient Medical Coding Auditor will extract clinical information from medical records and assign appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT). They will review inpatient hospital claims for proper reimbursement, handle provider disputes, and contribute to cost reduction by increasing the accuracy of provider contract payments and ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Responsibilities also include analyzing and manipulating databases, responding to internal requests for medical information, and making decisions regarding work methods with minimal direction.

Skills

Medical Coding
ICD-10-CM
CPT
MSDRG
Database Analysis
Medical Records Review
Provider Disputes
Claims Payment
Diagnosis Related Group (DRG)

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.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

Land your dream remote job 3x faster with AI