Medical Coding Auditor

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The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code 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.

• Where you Come In
• The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code 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.

As a Medical Coding Auditor for the Outpatient Facility/APC Coding Team you will:

• •Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
• •Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Outpatient Facility coding
• •Utilize encoders and various coding resources
• •Perform CPT/HCPCS Procedure reviews
• •Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
• •Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
• •Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
• •Complete appropriate system(s) entry regarding claim/encounter information
• •Support and participate in process and quality improvement initiatives

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, depending on business needs.

Required Qualifications – What it takes to Succeed

CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience

Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures

Strong knowledge of CPT/HCPCS coding

Experience reading & coding from operative reports

Chemotherapy and/or Therapeutic Infusion experience

Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information

Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities

Comfortable working in a production-based work environment

Ability to work independently and manage workload

Strong written and verbal communication skills; strong analytical, organizational and time management skills

Working knowledge of Microsoft Office Programs (Word, Excel)

Preferred Qualifications

5+ years prior coding experience

Outpatient facility auditing experience

Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology , Outpatient Itemized Bill reviews

Ambulatory Payment Classification (APC) coding experience

Radiation Oncology coding experience

Experience in prospective payment methodologies

Experience with the Claims Life Cycle including Accounts Receivable

3M Coder software experience

Additional Information :

Work at Home Requirements

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

• 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.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40