About Humana


Job Category:

Member Quality & Financials - Medical Coding


United States

Approximate Salary:

Not Specified

Position Type:

Full Time

DRG Validation Auditor

Humana - Work At Home, Kentucky

Posted: 11/19/2018


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 confirms appropriate diagnosis related group (DRG) 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.

The Auditor position is a virtual opportunity within the United States. Provides expert coding auditing, coding and documentation improvement education

• Performs DRG validation reviews 
• Utilizes encoders and various coding resources
• Conducts peer reviews to ensure compliance with coding guidelines and provides reports as needed
• 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 coding principles, government regulation, protocols 
• Ability to travel 10% or less of the work year for training, team meetings, possible onsite audits opportunities and implementation needs


Required Qualifications

  • 3 years of consecutive years of acute in-patient coding or in-patient auditing experience required within the last  2 years
  • RHIA, RHIT, or CCS,  Certification required
  • MS-DRG auditing or APR auditing experience
  • Acute in-patient  coding experience

Preferred Qualifications

• 3M Coder experience
• Prior work at home experience
• Experience with ICD-9 and ICD-10

• Experience with MS-DRG auditing or APR auditing

Additional Information

Scheduled Weekly Hours


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