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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.
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 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$59,300 - $80,900 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to e
