Remote Inpatient Coding Auditor - ICD-10 & DRG Expert

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

Job summary

Humana, a Fortune 100 Company, is seeking an experienced and Certified Inpatient Medical Coding Auditor to review hospital claims for proper reimbursement and resolve provider disputes.

You will extract clinical information from medical records, assign ICD-10-CM/PCS and DRG codes, audit coding quality, and collaborate with teams to improve payment accuracy and reduce errors. This remote position offers a competitive bonus plan and comprehensive benefits.

Qualifications

• 4+ years of MSDRG coding auditing experience.
• RHIA, RHIT or CCS certification, held for at least 4 years.
• Experience reading and interpreting claims; inpatient coding audits in health insurance or hospital setting.
• Ability to gather/reference data across multiple systems simultaneously.

Responsibilities

• Review inpatient medical records and claims for accurate coding and reimbursement.
• Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes.
• Audit coding quality and identify improvement opportunities.
• Investigate and resolve provider disputes with a fair, factual 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

Inpatient coding audits

Claims interpretation

Data gathering across systems

Job description

Humana, a Fortune 100 Company, is seeking an experienced and Certified Inpatient Medical Coding Auditor to review hospital claims for proper reimbursement and resolve provider disputes.

You will extract clinical information from medical records, assign ICD-10-CM/PCS and DRG codes, audit coding quality, and collaborate with teams to improve payment accuracy and reduce errors. This remote position offers a competitive bonus plan and comprehensive benefits.