Remote Inpatient Coding Auditor | DRG & ICD-10 Expert

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

Benefits offered by this job

Medical benefits

401(k) retirement plan

Paid time off

Job summary

Humana Inc. is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient claims for proper reimbursement and resolve provider disputes.

You will extract clinical information and assign ICD-10-CM, ICD-10-PCS, and DRG codes to patient records, ensuring coding accuracy and payment integrity. The role targets cost reduction by improving payment accuracy, with responsibilities spanning audits, data analysis, and cross-team collaboration.

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.

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

Interpreting claims

Data gathering across systems

Education

RHIA/RHIT/CCS Certification

Job description

Humana Inc. is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient claims for proper reimbursement and resolve provider disputes.

You will extract clinical information and assign ICD-10-CM, ICD-10-PCS, and DRG codes to patient records, ensuring coding accuracy and payment integrity. The role targets cost reduction by improving payment accuracy, with responsibilities spanning audits, data analysis, and cross-team collaboration.