[Remote] Medical Coding Auditor Evaluation & Management at Humana

San Antonio, Texas, United States

Apply Now

Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

CPC, CCS, COC, RHIA, or RHIT Certification through AAPC or AHIMA
Minimum of 3 years post-certification experience auditing Professional Evaluation & Management Services (Inpatient, Office, ER, Telehealth, Home Health, and minor procedures)
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
Passionate about contributing to an organization focused on continuously improving consumer experiences

Responsibilities

Review medical documentation for clinical indicators to ensure correct coding guidelines are met
Perform CPT/HCPCS code reviews for professional Evaluation and Management services: Inpatient services, office visit services, ER, Consultation services, Annual Wellness Services, and minor procedures
Confirm correct CPT coding assignments
Analyze, enter, and manipulate database
Respond to or clarify internal requests for medical information
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
Follow established guidelines/procedures
Make decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction

Skills

Key technologies and capabilities for this role

Medical CodingCPTHCPCSICD-10Evaluation and ManagementAuditingCPCCCSCOCRHIARHITEncodersClaims Review

Questions & Answers

Common questions about this position

Is this a remote position?

Yes, this is a remote work-at-home position, though occasional travel to Humana's offices for training or meetings may be required. Associates work on EST regardless of residence, starting between 6AM-9AM EST with some flexibility.

What certifications are required for this role?

Required certifications include CPC, CCS, COC, RHIA, or RHIT through AAPC or AHIMA.

What experience is needed for the Medical Coding Auditor position?

A minimum of 3 years post-certification experience auditing Professional Evaluation & Management Services is required, including Inpatient, Office, ER, Telehealth, Home Health, and minor procedures. 5 years of such experience is preferred.

What are the work hours for this job?

Associates work on EST, starting between 6AM-9AM EST with some flexibility depending on business needs.

What skills make a strong candidate for this role?

Strong candidates have the required certifications and 3+ years of auditing experience in E&M services, plus strong attention to detail, ability to work independently, handle multiple priorities, maintain confidentiality, and excellent communication skills. Passion for improving consumer experiences and preferred experience with claims life cycle or tools like Select Coder and 3M are also valued.

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

Try Jobo Free