Senior Inpatient Medical Coding Auditor Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Medical Coding & BillingIndustries

Requirements

Candidates should possess experience with inpatient medical coding, analytics, health record security and privacy, HIPAA compliance, and data governance, along with at least one of the following AHIMA Coding Certifications: RHIT, RHIA, or CCS. They must also have comprehensive knowledge of MS Word, Excel, and PowerPoint, and a passion for contributing to an organization focused on continuously improving consumer experiences.

Responsibilities

The Senior Inpatient Medical Coding Professional confirms appropriate diagnosis related group (DRG) assignments, analyzes and enters data into databases, responds to information requests, begins to influence department strategy, makes decisions on complex issues, reviews staff QA review variances, monitors daily inventory, assigns escalated inventory, researches guidelines from CMS and AMA, trains new coders/auditors, updates and maintains processes/resources/guidelines, serves as a point of contact for coders/auditors, assists with assignments, and engages with the team.

Skills

Inpatient medical coding

ICD-10-CM

ICD-10-PCS

DRG assignment

Medical records analysis

Database management

CMS guidelines

AMA guidelines

HIPAA compliance

Data governance

Training and mentoring

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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