Operational Staff Auditor evaluating internal processes and risk management at AES Corporation. Collaborating with teams to enhance operational efficiency and compliance.
About the role
- Inpatient Medical Coding Auditor for Humana reviewing inpatient hospital claims for proper reimbursement and contributing to cost reduction in healthcare. Remote position with occasional travel to office.
Responsibilities
- extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes to patient records
- reviews inpatient hospital claims for proper reimbursement
- handles provider disputes in a result-oriented and metrics-driven environment
- contributes to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems
- ensures correct claims payment and appropriate diagnosis related group (DRG) assignments
- analyzes, enters and manipulates database
- responds to or clarifies internal requests for medical information
Requirements
- RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years)
- MS-DRG coding/auditing experience
- Experience reading and interpreting claims
- Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings
- Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
- Strong attention to detail
- Can work independently and determine appropriate course of action
- Ability to handle multiple priorities
- Capacity to maintain confidentiality
- Excellent communication skills both written and verbal.
Benefits
- 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
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