Inpatient Medical Coding Auditor

📋 Description

• • As an Inpatient Medical Coding Auditor at Humana, you will play a pivotal role in ensuring the accuracy and integrity of our medical record data, directly impacting patient care and financial health. Your expertise will be crucial in reviewing inpatient hospital claims, meticulously extracting clinical information, and assigning appropriate procedural terminology and medical codes, including ICD-10-CM and CPT.
• • This role involves analyzing moderately complex to complex issues, requiring an in-depth evaluation of variable factors to ensure that our systems reflect the most accurate patient diagnoses and treatments. You will be instrumental in contributing to overall cost reduction by enhancing the precision of provider contract payments within our payer systems and guaranteeing correct claims payments and appropriate Diagnosis Related Group (DRG) assignments.
• • You will be responsible for conducting thorough reviews and audits of inpatient coding, working within a result-oriented and metrics-driven environment. Your analysis will extend to understanding and interpreting claims data, identifying discrepancies, and recommending corrective actions to maintain high standards of coding accuracy.
• • A key aspect of this position is your ability to analyze, enter, and manipulate database information. This involves working with clinical data to support coding accuracy and reimbursement integrity. You will also be the point of contact for internal requests for medical information, providing clear and concise explanations based on your expert knowledge.
• • This is a remote, work-at-home position, offering the flexibility to manage your work schedule within typical business hours (Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6 AM-6 PM), with potential for some flexibility based on business needs. While remote, occasional travel to Humana's offices for training or meetings may be required.
• • You will be expected to understand the broader organizational strategy and operating objectives, recognizing how your role contributes to the company's success in areas such as cost reduction, quality improvement, and member satisfaction.
• • Decision-making is a critical component of this role. You will be empowered to make decisions regarding your work methods, often in ambiguous situations, requiring minimal direction but knowing when to seek guidance. Adherence to established guidelines and procedures is paramount to ensure consistency and compliance.
• • Your work will directly influence the accuracy of provider contract payments, ensuring fair and appropriate reimbursement based on documented clinical services. This involves a deep understanding of MS-DRG coding and auditing principles.
• • You will be a key contributor to Humana’s mission of putting health first by ensuring that the clinical data accurately reflects the services provided, which in turn supports better healthcare decisions and outcomes for our members.
• • The role demands a strong analytical mindset, the ability to interpret complex medical documentation, and the skill to translate that information into accurate coded data. You will be working with sensitive patient information, so maintaining strict confidentiality and adhering to HIPAA regulations is non-negotiable.
• • You will collaborate with internal teams, providing insights and support related to coding practices and audit findings. Your communication skills, both written and verbal, will be essential in conveying complex information clearly and effectively.
• • This position offers the opportunity to work for a Fortune 100 company that is committed to the well-being of its consumers and staff, rewarding performance, and fostering a culture of continuous improvement and professional growth.
• • Your contributions will help Humana achieve its strategic goals by ensuring the financial integrity of our claims processing and supporting our commitment to providing high-quality, affordable healthcare.
• • You will be part of a dynamic team, working independently and collaboratively to meet performance metrics and contribute to the overall success of the auditing department.
• • The ability to manage multiple priorities effectively and maintain a high level of attention to detail will be crucial for success in this fast-paced, metric-driven environment.
• • This role is ideal for a self-motivated individual with a passion for medical coding and auditing, who thrives in a remote work setting and is dedicated to making a tangible impact on healthcare.