Medical Coding Auditor

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Responsibilities

• Confirms correct CPT coding assignments.
• Analyzes, enters, and manipulates database.
• Responds to or clarifies internal requests for medical information.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.
• Reviews medical documentation for clinical indicators to ensure correct coding guidelines are met.
• Performs CPT/HCPCS code reviews for professional Evaluation and Management Services: Inpatient services, office visit services, ER, Consultation services, Annual Wellness Services, and minor procedures.
• Maintain productivity metrics.
• Must maintain quality metrics.
• Utilize encoders and various coding resources.
• Maintain current working knowledge of ICD-10 and CPT coding principles, government regulation, protocols.
• Maintain strict patient and physician confidentiality.

Required Qualifications

• Certification: CPC, CCS, COC, RHIA, or RHIT Certification either through AAPC or AHIMA.
• Experience: Minimum of 3 years post-certification experience auditing Professional Evaluation & Management Services - Inpatient, Office, ER, Telehealth, Home Health, and minor procedures.
• Skills:
  • Strong attention to detail.
  • Working knowledge of Microsoft Office Programs (Word, PowerPoint, and Excel).
  • Ability to work independently and determine appropriate courses of action.
  • Ability to handle multiple priorities.
  • Capacity to maintain confidentiality.
  • Excellent communication skills, both written and verbal.

Preferred Qualifications

• Post-certification experience auditing Professional Evaluation & Management Services - Inpatient, Office, ER, Telehealth, Home Health, and minor procedures.
• Experience with SRO, eHub.
• Experience with the Claims Life Cycle.
• Experience in Select Coder, 3M.

Company Information & Benefits

Humana offers a remote opportunity for this role. As a Fortune 100 Company, we value associate engagement and your well-being. We also provide excellent professional development and continued education. Use your skills to make an impact.

Additional Information - How we Value You:

• Benefits starting day 1 of employment.
• Competitive 401k match.
• Generous Paid Time Off accrual.
• Tuition Reimbursement.
• Parent Leave.

Work at Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interview process.