Inpatient Medical Coding Auditor

Humana; United States; Remote; USD 71,000 - 98,000; Full time

Job summary

Join an innovative company dedicated to putting health first! As an Inpatient Medical Coding Auditor, you will play a vital role in ensuring accurate claims processing and reimbursement for inpatient hospital services. This position offers the flexibility of remote work, allowing you to thrive in a supportive and metrics-driven environment. Collaborate with a talented team while utilizing your expertise to contribute to cost reduction and enhance the quality of healthcare services. With a strong focus on professional development and employee well-being, this opportunity is perfect for those looking to make a significant impact in the healthcare industry.

Benefits

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Benefits starting day 1

Qualifications

• 4+ years of experience in medical coding with RHIA, RHIT, or CCS certification.
• Experience in inpatient coding reviews/audits in health insurance or hospital settings.

Responsibilities

• Review inpatient hospital claims for proper reimbursement and handle provider disputes.
• Analyze and manipulate databases to ensure accurate claims payment.

Skills

Medical Coding

Attention to Detail

Communication Skills

Independent Work

Multi-tasking

Education

RHIA Certification

RHIT Certification

CCS Certification

Tools

Microsoft Office (Word, PowerPoint, Excel)

Job description

Become a part of our caring community and help us put health first
The 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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Where you Come In
Humana is looking for an experienced 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 looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG).

The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

This is a 40 hour per week role and the work hours will be 8 hours a day Monday to Friday.

Use your skills to make an impact

WORK STYLE: 100% remote/work at home

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs.

Required Qualifications – What it takes to Succeed
• RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years)
• MS-DRG coding/auditing experience
• Minimum of 1 years' work experience reading and interpreting claims
• Minimum of 3 years’ experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings
• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Strong attention to detail
• Can work independently and determine appropriate course of action
• Ability to handle multiple priorities
• Capacity to maintain confidentiality
• Excellent communication skills both written and verbal

Preferred Qualifications
• Experience in APR DRG coding/ auditing
• Experience in Financial Recovery
• Experience in a fast paced, metric driven operational setting

Additional Information - How we Value You
• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave

Work at Home Requirements
• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
· At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
· Satellite, cellular and microwave connection can be used only if approved by leadership
· Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
· Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
· Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 04-03-2025

About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.