Humana, Inc.

Humana Inc. is seeking an experienced Certified Inpatient Medical Coding Auditor to review hospital claims for proper reimbursement and resolve provider disputes. The role involves assigning ICD-10-CM, ICD-10-PCS, and DRG codes, auditing coding quality, and driving cost savings by improving payment accuracy. Responsibilities include reviewing records, validating codes, and collaborating across teams. Remote, with potential travel for training; 40 hours/week, competitive bonus eligibility. #J-18808-Ljbffr

Become a part of our caring community The Inpatient 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 Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes 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). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of...

Become a part of our caring community The Senior Medical Coding Professional, Inpatient supports payment integrity initiatives by reviewing inpatient claims for coding accuracy, DRG assignment, and compliance with official guidelines. You will report to the Manager, Payment Integrity. Key Responsibilities Review inpatient records for coding accuracy and DRG validation Identify anomalies for audit targeting Apply ICD-10-CM/PCS coding guidelines and DRG logic Assess how coding impacts reimbursement and severity adjustment Conduct retrospective audits and document findings Recommend adjustments, recoveries, or provider education Collaborate with clinical reviewers and data analysts Use your skills to make an impact Required Qualifications Required: RHIA, RHIT, CCS, or CIC 5+ years inpatient coding experience Audit or validation experience Strong DRG knowledge (MS-DRG/APR-DRG) Understanding of CDI and severity of illness (SOI/ROM) concepts Preferred Qualifications 3M...

Become a part of our caring community Humana, a Fortune 100 Company, is looking for an experienced and Certified medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments. The Certified Inpatient 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 goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following: Review inpatient medical records and claims to ensure accurate coding and reimbursement Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes Audit coding quality and...