Inpatient Medical Coding Auditor
Please mention DailyRemote when applying
AI Summary
Become a part of our caring community
Are you a detail-driven coding expert who enjoys solving complex clinical puzzles and making a measurable impact on payment accuracy and provider satisfaction? Humana, a Fortune 100 Company, is looking for an experienced, Remote medical coding auditor to review inpatient hospital claims for proper reimbursement and resolve provider disputes. Your expertise will directly contribute to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, ensuring correct claims payment and appropriate diagnosis related group assignments.WORK HOURS are Monday-Friday, 8 hours per day, 40 hours per week, and are scheduled between 6AM-6PM. Potential shift to be discussed during the interview.
The Inpatient 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 goal is to ensure the accuracy and integrity of hospital claim payments. Responsibilities include the following:
- Review inpatient medical records and claims to ensure accurate coding and reimbursement
- Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes
- Audit coding quality and identify opportunities for improvement
- Investigate and resolve provider disputes with a fair, fact-based approach
- Analyze complex clinical documentation and coding scenarios
- Collaborate with other teams to clarify coding and medical information
- Contribute to cost savings by improving payment accuracy and reducing errors
Use your skills to make an impact
Required Qualifications
- Four or more years of MSDRG coding auditing experience
- RHIA, RHIT or CCS Certification (must have held certification for at least 4 years)
- Experience performing inpatient coding audits in a health insurance or hospital setting
- Experience reading and interpreting claims
- Proficiency in gathering or referencing data within different systems simultaneously
Preferred Qualifications
- Experience in APDRG coding/auditing
- Experience in Financial Recovery
- Experience in a metric driven operational setting
Work at Home Requirements
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.Application Deadline: 06-08-2026
About us
About Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Automatically Apply to the Best Remote Jobs
Stop the endless job search. Our AI finds and applies to the best jobs for you.
