Medical Coding Quality Auditor

Become a part of our caring community and help us put health first
 The Quality Assurance department is looking for Medical Coding Quality Auditor for outpatient setting with Evaluation Management leveling experience, DME and IR. This role will complete quality reviews on the coding processes within the Payment Integrity organization, focusing on the IR and multiple specialties for Outpatient Coding Team and vendor partners.

Medical Coding Quality Auditor

The Quality Assurance department is seeking a Medical Coding Quality Auditor for the outpatient setting, with experience in Interventional Radiology, Durable Medical Equipment (DME), Multi-Specialty Pro-fee, and Evaluation and Management. This role involves conducting quality reviews of coding processes within the Payment Integrity organization, focusing on Interventional Radiology, DME, Evaluation and Management, and multiple specialties for outpatient coding teams and vendor partners.

Key Responsibilities:

• Develop and implement policies, procedures, and methods to ensure operational quality and continuous improvement.

• Conduct training and coaching for staff and management in areas such as quality improvement, process management, and reliability science.

• Maintain effective and collaborative communication with administration, stakeholders, and vendor partners.

• Understand department, segment, and organizational strategies and operating objectives, including their linkages to related areas.

• Make decisions regarding work methods, occasionally in ambiguous situations, with minimal direction and guidance as needed.

• Follow established guidelines and procedures to ensure compliance with federal, state, and payer regulations.

So, do you love working on several different projects? Do you take pride in helping others and being flexible? Do you have great attention to detail and a passion for healthcare? Do you have a solid background in medical auditing, coding, and medical record review? If you answered YES to one or more of the above, you should strongly consider this role.

Use your skills to make an impact
 

WORK STYLE:  Remote/Work at Home

WORK HOURS: Full time: Monday-Friday, 8 hours/day, 5 days/week

This role will complete quality reviews on the coding processes within the Payment Integrity organization, vendor partners focusing on the Outpatient Coding teams and various processes.  This is a full-time remote/work-at-home opportunity.

Required Qualifications

• 5+ years of Evaluation and Management and DME.

• 7 years of Profee and Surgery Auditing.

• Medical coding certification from AAPC OR AHIMA (CPC, CCS, CIC, CPMA or equivalent).

• Strong critical thinking skills.

• Prior experience reading and coding from medical records.

• Demonstrated ability to work independently and manage workload.

• Exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence, and commitment to the profession.

• Excellent writing, editing, interpersonal, planning, teamwork, and communication skills.

• Proficient in MS Office applications including Word, Excel, Outlook, PowerPoint.

• Prior experience working independently and determining appropriate courses of action.

• Demonstrated experience in effective communication with internal customers through both written and verbal communication.

Preferred Qualifications

• Inpatient experience.

• Interventional radiology.

• Process improvement experience.

• Multi-Specialty Auditing experience.

Additional Information

Work at Home Requirements

•            At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

•            Satellite, cellular and microwave connection can be used only if approved by leadership

•            Associates 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 associates 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

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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 to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Pay 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.

 

$65,000 - $88,600 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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: 03-27-2025
About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

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