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Job Information

Humana DRG Inpatient Validation Auditor in Aberdeen, South Dakota

Description

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.

Responsibilities

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

40

About Us

Mission: 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 that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It 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 Security

Humana 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.

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