Medical Coding Auditor
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 audits medical charts and records for compliance with federal coding regulations. Provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements.
Essential Functions
- You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions
- You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines
- You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines
- You will prepare written summaries of audit findings
- You will present verbal audit feedback and provide education upon completion of the medical record audit
- You will respond to or clarify internal requests for information
- You will support and participate in process and quality improvement projects
- You will partner with business associates from other departments to understand their needs and concerns, and help develop system solutions
- You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
- You will make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed.
- You will follow established guidelines/procedures
- You will help code capacities
Required Qualifications
- This position requires both a CPMA AND CRC and it also requires at least ONE of the certifications from AAPC or AHIMA from the list below:
- CPC - Certified Professional Coder (AAPC)
- CCS - Certified Coding Specialist (AHIMA)
- CCS-P - Certified Coding Specialist-Physician Based (AHIMA)
- 2 or more years of outpatient coding experience (Preferably in a risk adjustment setting)
- Knowledge of several reimbursement methodologies, including risk adjustment and fee for service
- Must maintain annual continuing education requirements and remain in good standing with the certification governing body
- Will work in a goal-oriented environment that is production and quality driven
- Passionate about contributing to an organization focused on continuous improvement
- Proficient in all Microsoft Office applications, including Word and Excel
- Public speaking / group presentation skills
- Ability to travel locally and overnight within Conviva and CenterWell markets per business need
Preferred Qualifications
- CDEO
- Bachelor's Degree
- Experience with Athena and eCW (Electronic Medical Records)
- Outpatient auditing experience, preferably in a risk adjustment setting
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 $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") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.