[Remote] Medical Coding Auditor at Humana

Puerto Rico

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Must reside in Puerto Rico
Bilingual (English/Spanish)
3 years of Outpatient coding and Outpatient auditing experience within the last 5 years, including CPT surgical coding and auditing
Certified Medical Coder with at least one of the following credentials: RHIA, RHIT, CCS or CPC through AHIMA or AAPC
Demonstrated ability to lead process/project initiatives

Responsibilities

Extract clinical information from medical records and assign appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT)
Confirm correct CPT coding assignments
Analyze, enter, and manipulate databases
Respond to or clarify internal requests for medical information
Review medical documentation to ensure correct coding guidelines are followed
Utilize encoders and various coding resources
Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
Maintain strict patient and physician confidentiality and follow all federal, state, and hospital guidelines for release of information
Maintain current working knowledge of ICD-10 and CPT coding principles, government regulations, and protocols

Skills

ICD-10-CM

CPT

Medical Coding

Coding Audit

Outpatient Coding

Encoders

Peer Review

HIPAA Compliance

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.

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