Inpatient DRG Quality Auditor

Humana; Iowa (LA); Remote; USD 65,000 - 89,000; Full time

Job summary

Join a leading healthcare company as an Inpatient Medical Coding Auditor. In this fully remote role, you'll conduct quality reviews, drive process improvements, and develop educational materials. We're looking for experienced auditors with a strong background in medical coding and auditing. Enjoy a supportive work environment that values your contributions and offers professional development opportunities.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

401(k)

Paid Time Off

Disability Insurance

Life Insurance

Qualifications

• 7+ years of DRG Coding experience.
• 5 years of Quality Auditing experience.

Responsibilities

• Conduct quality reviews of coding processes and focus on DRG audits.
• Drive process improvements and develop educational materials.

Skills

Critical Thinking

Communication

Teamwork

Education

Medical Coding Certification from AHIMA

Tools

MS Office

Job description

Become a part of our caring community and help us put health first

In this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop educational materials. This is a full-time, remote/work-from-home position.

Description

The Inpatient Medical Coding Auditor extracts clinical information from medical records and assigns appropriate codes (e.g., ICD-10-CM, CPT). This role involves analyzing moderately to highly complex issues requiring in-depth evaluation of variable factors.

Where you Come In

The Coding Quality Team is looking for an experienced and well-grounded medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are seeking to work from home for a Fortune 100 company that values well-being and rewards performance, consider the role of Inpatient Coding Auditor (MSDRG).

Do you enjoy working on multiple projects? Are you proud of helping others, flexible, detail-oriented, and passionate about healthcare? Do you have a strong background in medical auditing, coding, and record review? If you answered YES to any of these, this role might be for you.

What Humana Offers

We offer a remote position with a company that values engagement and well-being. We provide professional development and continued education opportunities.

Use your skills to make an impact

• WORK STYLE: 100% remote/work from home
• WORK HOURS: Monday-Friday, 8 hours/day, with some flexibility depending on business needs

Responsibilities

Conduct quality reviews of coding processes, focus on DRG audits, drive process improvements, and develop educational materials.

Required Qualifications

• 7+ years of DRG Coding experience
• 5 years of Quality Auditing experience
• Medical coding certification from AHIMA (RHIT, CCS, CICA, CHCA)
• Experience reading and coding from medical records
• Strong critical thinking skills
• Ability to manage diverse priorities independently
• Proven ability to work independently and manage workload
• Professionalism, flexibility, dependability, and commitment to excellence
• Excellent communication, writing, editing, and teamwork skills
• Proficiency in MS Office applications

Work at Home Requirements

• High-speed DSL or cable modem (Satellite and Wireless not allowed)
• A dedicated, interruption-free workspace to protect PHI/HIPAA information

Preferred Qualifications

• Experience with CAS, MOATS, and FR
• Process improvement experience
• Multi-Specialty Auditing experience

Additional Information

Scheduled weekly hours: 40

Pay range: $65,000 - $88,600 annually, based on location and experience. Bonus potential based on performance.

Description of Benefits

Humana offers medical, dental, vision, 401(k), paid time off, disability, life insurance, and more, supporting your well-being and personal growth.

Interview Process

We use HireVue for interviews, allowing flexible scheduling. Occasional travel to Humana offices may be required.

About us

Humana is dedicated to health and well-being, serving diverse communities and making healthcare accessible and effective.

Equal Opportunity Employer

Humana values diversity and is committed to equal opportunity employment and affirmative action, ensuring a fair and inclusive workplace.