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Humana Bilingual (English/Spanish) Medical Coding Auditor-WAH-US and Puerto Rico in Billings, Montana

Description

The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g. 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 correct CPT coding 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.

  • Review medical documentation to ensure correct coding guidelines followed

  • Utilize encoders and various coding resources

  • Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed

  • Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information

  • Maintain current working knowledge of ICD-9, ICD-10 and CPT coding principles, government regulation, protocols

Required Qualifications

  • Bilingual (English/Spanish)

  • 3 consecutive years of Outpatient coding and Outpatient auditing experience required within the last 5 years. Experience needs to include CPT surgical coding and auditing.

  • Certified Medical Coder with at least one of the following credentials: RHIA, RHIT, CCS or CPC through either AHIMA or AAPC

  • Demonstrated ability to lead process/project initiatives

Preferred Qualifications:

  • Associate's Degree in relevant field

  • Experience in Select Coder and/or 3M

  • 5 years of consecutive Profee surgical coding and auditing

  • Experience in Financial recovery

Scheduled Weekly Hours

40

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