Certified Inpatient Medical Coding Auditor

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

Job summary

Humana, a Fortune 100 Company, is seeking an experienced and Certified Inpatient Medical Coding Auditor to review hospital claims for proper reimbursement and resolve provider disputes.

You will extract clinical information from medical records, assign ICD-10-CM/PCS and DRG codes, audit coding quality, and collaborate with teams to improve payment accuracy and reduce errors. This remote position offers a competitive bonus plan and comprehensive benefits.

Qualifications

• 4+ years of MSDRG coding auditing experience.
• RHIA, RHIT or CCS certification, held for at least 4 years.
• Experience reading and interpreting claims; inpatient coding audits in health insurance or hospital setting.
• Ability to gather/reference data across multiple systems simultaneously.

Responsibilities

• Review inpatient medical records and claims for accurate coding and reimbursement.
• Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes.
• Audit coding quality and identify improvement opportunities.
• Investigate and resolve provider disputes with a fair, factual 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

Claims interpretation

Data gathering across systems

Job description

Become a part of our caring community

Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments.

The Certified Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records.

The goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following:

• 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

Use your skills to make an impact

Required 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
• Proficiency in gathering or referencing data within different systems simultaneously

Preferred Qualifications

• Experience in APDRG coding/auditing
• Experience in Financial Recovery
• Experience in a metric driven operational setting

Additional Information

WORK HOURS are Monday-Friday, 8 hours per day, 40 hours per week, and are scheduled between 6AM-6PM. Potential shift to be discussed during the interview.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 07-31-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.