Role: DRG Validation Auditor
Assignment: Provider Network Operations
Location: Virtual - Work at Home
Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.
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
Role Essentials: • 3 years of consecutive years of acute in-patient coding or in-patient auditing experience required within the last 2 years
- Certified Medical Coder with at least one of the following credentials: CCS, RHIA, RHIT
- Strong communication skills both written and verbal • Microsoft Excel skills
Role Desirables: • 3M Coder experience • Prior work at home experience • Experience with ICD-9 and ICD-10
- Experience with MS-DRG auditing or APR auditing
Reporting Relationships You will report to a Business Consultant. This area is under the leadership of the SVP & Chief Operating Officer
Additional Information At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
Are you a Certified Medical Coder with at least one of the following credentials: CCS, RHIA or RHIT?
Do you have 3 consecutive years of acute in-patient coding experience? If so where and when?
Do you have experience with MS-DRG auditing, if so how long and where?
Do you have experience with APR auditing, where and how long?
Do you have experience with 3M software? Beginner, Intermediate or Advanced:
This role is work at home and requires a certain internet speed. Confirm internet connection speed of 10 x 1. You can confirm with internet service provider or go to www.speedtest.net to check connection speed. Are you able to meet this requirement?
What is your salary range you are seeking?
Apply to Requisition # 186027 DRG Validation Auditor at Humana.com