Medical Coding Auditor (Outpatient)

About this role

Become a part of our caring community   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.

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.

Use your skills to make an impact   Additional Job Description

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, once training is complete and depending on business needs. Associates are expected to start each workday between 6AM-9AM EST, regardless of their home time zone.

Required Qualifications – What it takes to Succeed  • 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 including knowledge of outpatient coding conventions and standards

• Strong knowledge of NCD/LCDs, CMS Manual, NCCI Edits, and coding guidelines

• 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

• Minimum of 3 years' experience reading and interpreting claims

• Outpatient facility auditing experience

• 3M Coder software experience

• CRM/SRO, Pareo, MOAT experience

• Prior appeals and/or disputes auditing experience

• Experience in Financial Recovery

• Experience in a fast paced, metric driven operational setting

• Advanced and/or Specialty Coding Certifications

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

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 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

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