Remote Inpatient Coding Auditor (ICD-10/DRG)

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

Job summary

Humana is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. The role focuses on assigning ICD-10-CM, ICD-10-PCS, and DRG codes while ensuring accuracy of payments and contract alignment.

The candidate will analyze complex documentation, audit coding quality, and collaborate with teams to improve payment accuracy. Remote position with occasional travel and a 40-hour workweek.

Qualifications

• 4+ years of MSDRG coding auditing experience.
• 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

Inpatient coding audits

Claims interpretation

Data retrieval across systems

Education

RHIA/RHIT or CCS Certification

Job description

Humana is seeking an experienced Certified Inpatient Medical Coding Auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. The role focuses on assigning ICD-10-CM, ICD-10-PCS, and DRG codes while ensuring accuracy of payments and contract alignment.

The candidate will analyze complex documentation, audit coding quality, and collaborate with teams to improve payment accuracy. Remote position with occasional travel and a 40-hour workweek.