Role Description
The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
• Confirms correct CPT coding assignments.
• Analyzes, enters, and manipulates the claim in the respective database.
• Responds to or clarifies internal requests for medical information.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.
• Reviews medical documentation for clinical indicators to ensure procedures meet clinical criteria and correct coding guidelines.
• Utilizes encoders and various coding resources.
• Performs CPT Procedure reviews.
• Maintains strict patient and physician confidentiality and follows all federal, state, and hospital guidelines for release of information.
• Maintains current working knowledge of ICD-10 and CPT coding principles, government regulation, protocols.
Qualifications
• Minimum of 3+ years post certification experience in Outpatient Specialty Surgeries and Procedures for Physicians.
• RHIA, RHIT, CCS, CPC, or COC Certification.
• Strong knowledge of NCD/LCDs, CMS Manual, NCCI Edits, and coding guidelines.
• Experience reading & coding from operative reports.
• 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.
Requirements
• STRONGLY PREFERRED: Experience with coding/auditing multispecialty surgical procedures.
• Experience with coding/auditing Professional Inpatient Claims.
• Experience in Select Coder, 3M.
• Experience with the Claims Life Cycle.
Benefits
• 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.
• Many other opportunities.
Company Description
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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.