Humana

About Humana

 

Job Category:

Member Quality & Financials - Medical Coding

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full Time

Medical Coding Auditor-Louisville, KY or WAH EST or CST zones

Humana - Louisville, Kentucky

Posted: 11/11/2018

Description

The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guideline are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guideline are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


As a Medical Coding Auditor for Clinical Audits with the Internal Audit Team you will:
•    Review medical documentation for clinical indicators to ensure specific diagnoses and or procedures meet clinical criteria and correct coding guidelines
•    Utilize encoders and various coding resources
•    Perform CPT 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-9, ICD-10 and CPT coding principles, government  regulation, protocols
•    Travel 10% or less of the work year for training, team meetings, possible onsite audits opportunities and implementation needs
 

               

Required Qualifications
•    High school diploma or equivalent
•    Certified Medical Coder with at least one of the following credentials: RHIA, RHIT, CCS or CPC through either AHIMA or AAPC
•    3 years of consecutive years of Outpatient Surgical coding and Outpatient Auditing experience required within the last 5 years.  Experience needs to include CPT surgical coding and auditing.  
•    Demonstrated ability to lead process/project initiatives
•    MS office proficiency 
•    Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information 
•    Ability to work independently and manage work load
•    Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession 
•    Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
Preferred Qualifications
•    Associate's Degree in relevant field preferred
•    Experience in cardiology, orthopedics and/or neurosurgery
•    Experience in encoder pro, 3M 
•    Prospective payment methodologies, auditing experience

Additional Information
Interview Format 

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. 
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. 
 

Scheduled Weekly Hours

40

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