Medical Coding Auditor – Outpatient
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Job Description
Medical Coding Auditor reviewing outpatient medical records and claims for Humana’s U.S. healthcare and insurance services. Assigning ICD-10-CM and CPT codes while independently determining audit outcomes.
Responsibilities:
- Extract clinical information from a variety of medical records
- Assign appropriate procedural terminology and medical codes, including ICD-10-CM and CPT, to patient records
- Interpret varied work assignments and independently determine appropriate courses of action
- Audit outpatient medical records and claims
- Handle and disseminate information with judgment and discretion
- Work in a production-based environment and manage multiple priorities
- Participate in pre-recorded voice and/or SMS text interviews during the hiring process
- Occasionally travel to Humana offices for training or meetings
Requirements:
- CPC, COC, CCS, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience
- Minimum of 2 years of outpatient medical record auditing experience
- Knowledge of outpatient coding conventions and standards
- Strong knowledge of NCD/LCDs, CMS Manual, NCCI Edits, and coding guidelines
- Ability to exercise solid judgment and discretion in handling and disseminating information
- Strong attention to detail
- Ability to work independently and determine appropriate course of action
- Ability to handle multiple priorities
- Comfortable working in a production-based work environment
- Ability to manage workload independently
- Strong written and verbal communication skills
- Strong analytical, organizational, and time management skills
- Working knowledge of Microsoft Office programs, including Word and Excel
- Associates are expected to start each workday between 6AM-9AM EST, regardless of home time zone
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
- Home internet with at least 25 Mbps download and 10 Mbps upload speed
- Preferred: 5+ years prior coding experience; minimum 3 years reading and interpreting claims; outpatient facility auditing experience; 3M Coder software experience; CRM/SRO, Pareo, or MOAT experience; prior appeals and/or disputes auditing experience; financial recovery experience; fast-paced, metric-driven operational experience; advanced and/or specialty coding certifications
Benefits:
- Bonus incentive plan based upon company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Internet expense payment for associates working from home in California, Illinois, Montana, or South Dakota
- Telephone equipment provided for Home or Hybrid Home/Office associates
- Remote work at home
- Flexible start time may be possible after training, depending on business needs
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