Certified Inpatient Coding Auditor — Remote

Humana Inc; Columbus (OH); On-site; USD 71,100 - 97,800; Full time

Benefits offered by this job

Bonus incentive plan

Medical, dental & vision benefits

Job summary

Humana Inc. is seeking an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes.

The role focuses on accurate ICD-10-CM, ICD-10-PCS, and DRG coding, with opportunities to improve payment accuracy and drive cost savings. Responsibilities include auditing inpatient records, validating codes, investigating disputes, and collaborating with teams.

Qualifications

• 4+ years of MSDRG coding auditing experience.
• RHIA, RHIT or CCS Certification (must have held certification for at least 4 years).
• Experience performing inpatient coding audits in a health insurance or hospital setting.
• Experience reading and interpreting claims.

Responsibilities

• Review inpatient medical records and claims to ensure accurate coding and reimbursement.
• Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes.
• Audit coding quality and identify opportunities for improvement.
• Investigate and resolve provider disputes with a fair, fact-based approach.
• Analyze complex clinical documentation and coding scenarios.
• Collaborate with other teams to clarify coding and medical information.
• Contribute to cost savings by improving payment accuracy and reducing errors.

Skills

MSDRG coding auditing

RHIA/RHIT/CCS Certification

Inpatient coding audits

Reading claims

Education

RHIA, RHIT or CCS Certification

Job description

Humana Inc. is seeking an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes.

The role focuses on accurate ICD-10-CM, ICD-10-PCS, and DRG coding, with opportunities to improve payment accuracy and drive cost savings. Responsibilities include auditing inpatient records, validating codes, investigating disputes, and collaborating with teams.