Inpatient Medical Coding Auditor

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The Inpatient Medical Coding Auditor - MSDRG appeals reporting to the Manager reviews the appropriate DRG and ICD-10-CM/ PCS coding assignments for accuracy within the appeals team from a variety of medical records.

The Disputes Auditor - MSDRG Inpatient Coding consults and collaborates with coding professionals within and across departments to ensure high accountability of coding disputes outcomes for timeliness, compliance and quality.
- Will be an experienced medical coding auditor with in-depth experience in inpatient coding audits (MSDRG/APDRG)
- Ensures overall accuracy and compliance of coding appeal reviews by adhering to all appropriate coding guidelines and communicates appeals outcomes to providers in a professional and concise manner.
- Leverages advanced auditing expertise to make coding decisions based on standard industry guidelines and best practices
- Manages multiple priorities, collaborates with peers and ensures timely completion of inpatient coding appeals

Use your skills to make an impact

WORK STYLE: Remote, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week-- some flexibility might be possible, once training is complete and depending on business needs.

Associates are expected to start each workday between 6AM-9AM EST, regardless of their home time zone.

Required Qualifications
- RHIA, RHIT, or CCS Certification
- At least 2 years' experience in acute in-patient coding experience and/or MS-DRG auditing
- Recent experience auditing using CMS Manual, LCD, NCD, and Coding Guidelines
- Experience reading and interpreting claims
- Excellent written and verbal communication skills
- Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
- Strong attention to detail
- Can work independently and determine appropriate course of action
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications
- Associate's Degree or higher in Health Information Management (HIM)
- Experience in Financial Recovery
- Experience in a fast paced, metric driven operational setting
- Experience in APR DRG coding/auditing

Additional Information

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 required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees 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

Our Hiring Process

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 for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

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