Medical Coding Auditor - Humana
San Juan, PR
About the Job
Become a part of our caring community and help us put health first
The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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.
Where you Come In
The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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.
As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will:
+ Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
+ Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding
+ Utilize encoders and various coding resources
+ Perform CPT/HCPCS Procedure reviews
+ Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
+ Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
+ Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
+ Complete appropriate system(s) entry regarding claim/encounter information
+ Support and participate in process and quality improvement initiatives
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.
Use your skills to make an impact
WORK STYLE: 100% work at home/remote
WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week-- some flexibility might be possible, depending on business needs
Required Qualifications – What it takes to Succeed
+ CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience
+ Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures
+ Strong knowledge of CPT/HCPCS coding
+ Experience reading & coding from operative reports
+ Chemotherapy/Therapeutic Infusion experience
+ 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
+ Demonstrated ability to exercise solid judgement and discretion in handling and disseminating information
+ 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 post certification experience reading and interpreting claims
+ Outpatient facility auditing experience
+ Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology
+ Ambulatory Payment Classification (APC) coding experience
+ Radiation Oncology coding experience
+ Experience in prospective payment methodologies
+ Experience with the Claims Life Cycle including Accounts Receivable
+ 3M Coder software experience
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”) 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.
Application Deadline: 02-23-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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.
Where you Come In
The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The 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 for appropriate CPT/ HCPCS code 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.
As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will:
+ Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
+ Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding
+ Utilize encoders and various coding resources
+ Perform CPT/HCPCS Procedure reviews
+ Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
+ Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
+ Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
+ Complete appropriate system(s) entry regarding claim/encounter information
+ Support and participate in process and quality improvement initiatives
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.
Use your skills to make an impact
WORK STYLE: 100% work at home/remote
WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week-- some flexibility might be possible, depending on business needs
Required Qualifications – What it takes to Succeed
+ CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience
+ Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures
+ Strong knowledge of CPT/HCPCS coding
+ Experience reading & coding from operative reports
+ Chemotherapy/Therapeutic Infusion experience
+ 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
+ Demonstrated ability to exercise solid judgement and discretion in handling and disseminating information
+ 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 post certification experience reading and interpreting claims
+ Outpatient facility auditing experience
+ Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology
+ Ambulatory Payment Classification (APC) coding experience
+ Radiation Oncology coding experience
+ Experience in prospective payment methodologies
+ Experience with the Claims Life Cycle including Accounts Receivable
+ 3M Coder software experience
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”) 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.
Application Deadline: 02-23-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana