Become a part of our caring community and help us put health first
 

The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Where you come in

The Medical Coding Auditor confirms correct CPT coding 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.

• Review medical documentation for clinical indicators to ensure correct coding guidelines are met

• Perform CPT/HCPCS code reviews for professional Evaluation and Management services: Inpatient services, office visit services, ER, Consultation services, Annual Wellness Services, and minor procedures

• Maintain productivity metrics

• Must maintain quality metrics

• Utilize encoders and various coding resources

• Maintain current working knowledge of ICD-10 and CPT coding principles, government regulation, protocols

• Maintain strict patient and physician confidentiality

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. 

Use your skills to make an impact
 

Required Qualifications – What it takes to Succeed

• CPC, CCS, COC, RHIA, or RHIT Certification either through AAPC or AHIMA

• Minimum of 3 years post-certification experience auditing Professional Evaluation & Management Services - Inpatient, Office, ER, Telehealth, Home Health, and minor procedures

• Strong attention to detail

• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel

• Can work independently and determine appropriate courses of action

• Ability to handle multiple priorities

• Capacity to maintain confidentiality

• Excellent communication skills both written and verbal

Preferred Qualifications

• Post-certification experience auditing Professional Evaluation & Management Services - Inpatient, Office, ER, Telehealth, Home Health, and minor procedures

• Experience with SRO, eHub

• Experience with the Claims Life Cycle

• Experience in Select Coder, 3M

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.

Travel: While this is a rem