Medical Coding Auditor Evaluation amp Management experience required

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Job Information

Humana

Medical Coding Auditor (Evaluation & Management experience required)

in

Louisville

Kentucky

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 confirms correct CPT coding 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.

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

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

Required Qualifications

RHIA, RHIT, CCS, COC or CPC Certification with 3 years of post-certification experience

Minimum of 5 years post certification in auditing Physician Evaluation and Management Claims, ER, Inpatient Professional Services

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Bachelor's Degree- Healthcare Related

Experience with the Claims Life Cycle

Experience with coding/auditing Professional Inpatient Claims

Experience in Select Coder, 3M

Additional Information

As part of our screening process, candidates will be required to take and pass a coding test prior to hire

Scheduled Weekly Hours

40

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.

Company info

Humana Inc.
Website : http://www.humana.com