Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtu

at Humana in Wilmington, Delaware, United States

Job Description


The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


Where you Come In

Humana is looking for an experienced medical coding auditor to handle provider disputes and appeals in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG/APDRG) – Outcomes Assurance Team opportunity with Humana.

The Inpatient 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 and appropriate diagnosis related group (DRG) 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.

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.

This is a 40 per week role and the work hours will be 8 hours a day Monday to Friday

Required Qualifications – What it takes to Succeed

  • RHIA, RHIT or CCS Certification
  • MS-DRG auditing experience
  • Minimum of 1 years’ work experience reading and interpreting claims
  • Minimum of 3 years’ experience in performing inpatient coding audits in health insurance and/or hospital settings and working coding-related disputes and trending results
  • Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
  • Strong attention to detail
  • Can work independently and determine appropriate course of action
  • Ability to handle multiple priorities
  • Capacity to maintain confidentiality
  • Excellent communication skills both written and verbal
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • We will require?full COVID vaccination for this job as we are a?healthcare?company committed to putting health and safety first for our members, patients, associates and the communities we serve.
  • If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law.

Preferred Qualifications

  • High School Diploma, GED or job related certification
  • Associate’s Degree or higher in Health Information Management (HIM)

APR-DRG auditing experience

  • Experience in Financial Recovery
  • Experience in a fast paced, metric driven operational setting

Additional Information – How we Value You

  • Benefits starting day 1 of employment
  • Competitive 401k match
  • Generous Paid Time Off accrual
  • Tuition Reimbursement
  • Parent Leave
  • Go365 perks for well-being
  • Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
  • Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

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.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

\#ThriveTogether #WorkAtHome

Scheduled Weekly Hours


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Job Posting: JC194751579

Posted On: Oct 13, 2021

Updated On: Nov 04, 2021