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DRG Inpatient Validation Auditor

Company: Humana
Location: Green Bay
Posted on: November 10, 2019

Job Description:

DescriptionThe 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.ResponsibilitiesThe 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 needsRequired 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 experiencePreferred Qualifications 3M Coder experience Prior work at home experience Experience with ICD-9 and ICD-10 Experience with MS-DRG auditing or APR auditingAdditional InformationScheduled Weekly Hours40About UsMission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity EmployerIt is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.Humana Safety and SecurityHumana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.

Keywords: Humana, Green Bay , DRG Inpatient Validation Auditor, Accounting, Auditing , Green Bay, Wisconsin

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