Inpatient DRG Quality Auditor

Humana; Houston (TX); Remote; USD 75,000 - 89,000; Full time

Job summary

A leading healthcare services company is seeking a Coding Auditor to conduct quality reviews, drive process improvements, and handle provider disputes. This role offers remote flexibility and comprehensive benefits, including professional development opportunities. Ideal candidates will have extensive experience in DRG coding and quality auditing, alongside relevant certifications.

Benefits

Comprehensive benefits including medical, dental, vision

401(k)

Paid time off

Professional development opportunities

100% remote work flexibility

Qualifications

• Minimum of 7 years of DRG Coding experience.
• At least 5 years of Quality Auditing experience.

Responsibilities

• Conduct quality reviews of coding processes within the Claims Cost Management organization.
• Drive process improvement initiatives and develop educational materials.
• Analyze moderately to highly complex issues requiring in-depth evaluation.

Skills

Critical Thinking

Communication

Education

Medical Coding Certification

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Salary up to $88,600 per year
- Eligible for a bonus incentive plan based on performance
- Comprehensive benefits including medical, dental, vision, 401(k), paid time off, and more
- Opportunity for professional development and continued education
- 100% remote work flexibility
- Work for a Fortune 100 company dedicated to employee well-being

What to Expect (Job Responsibilities):
- Conduct quality reviews of coding processes within the Claims Cost Management organization, focusing on DRG audits
- Drive process improvement initiatives and develop educational materials
- Handle provider disputes in a metrics-driven environment
- Analyze moderately to highly complex issues requiring in-depth evaluation
- Extract clinical information from medical records and assign appropriate codes (e.g., ICD-10-CM, CPT)

What is Required (Qualifications):
- Minimum of 7 years of DRG Coding experience
- At least 5 years of Quality Auditing experience
- Medical coding certification from AHIMA (RHIT, CCS, CICA, CHCA)
- Strong critical thinking skills and ability to manage diverse priorities
- Excellent writing, editing, interpersonal, and communication skills

How to Stand Out (Preferred Qualifications):
- Experience with CAS, MOATS, and FR
- Background in process improvement
- Multi-specialty auditing experience

#HealthcareServices #RemoteWork #CodingAuditor #CareerOpportunity #CompetitiveBenefits

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