Louisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to off
Medical Coding Auditor
Location
California + 3 moreAll locations: California | Illinois | Montana | South Dakota
Posted
1 day ago
Salary
$59.3K - $80.9K / year
Seniority
Senior
Job Description
Medical Coding Auditor
Humana
Medical Coding Auditor Location: United States Job Description: Become a part of our caring community The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor''s work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code 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. Where you Come In The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The Medical Coding Auditor's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code 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. As a Medical Coding Auditor for the Outpatient Facility/APC Coding Team you will: - Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered - Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Outpatient Facility coding - Utilize encoders and various coding resources - Perform CPT/HCPCS Procedure reviews - 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-10 and CPT coding guidelines, government regulation and protocols - Complete appropriate system(s) entry regarding claim/encounter information - Support and participate in process and quality improvement initiatives Use your skills to make an impact WORK STYLE: Remote, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Some flexibility might be possible, depending on business needs. Required Qualifications - What it takes to Succeed - CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience - Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures - Strong knowledge of CPT/HCPCS coding - Experience reading & coding from operative reports - Chemotherapy and/or Therapeutic Infusion experience - Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information - Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities - Comfortable working in a production-based work environment - Ability to work independently and manage workload - Strong written and verbal communication skills; strong analytical, organizational and time management skills - Working knowledge of Microsoft Office Programs (Word, Excel) Preferred Qualifications - 5+ years prior coding experience - Outpatient facility auditing experience - Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology, Outpatient Itemized Bill reviews - Ambulatory Payment Classification (APC) coding experience - Radiation Oncology coding experience - Experience in prospective payment methodologies - Experience with the Claims Life Cycle including Accounts Receivable - 3M Coder software 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 What Humana Offers We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. 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. Travel: While this is a remote position, occasional travel to Humana''s offices for training or meetings may be required. 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. $59,300 - $80,900 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. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.
Related Guides
Related Categories
Related Job Pages
More Auditor Jobs
Title: Auditor Location: Boston, MA / Hybrid/ Philadelphia, PA Job Description: Finance / Full Time Hybrid Auditor Employment Type: Full-Time, Mid-Level Department: Financial CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection. The ideal candidate will develop, coordinate, and draft technical audit guidelines, is proficient in a variety of accounting systems, and practices excellent cross-functional communication throughout investigations. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities. Skills and attributes for success: - Analyze and audit a variety of accounting systems. - Analyze, organize, and present a large volume of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary evidence, etc., through the use of common software programs. - Assist with the planning of investigations, including performing quantitative and qualitative analyses to identify potential witnesses and relevant financial documents. - Prepare concise and accurate reports of results of analysis, including detailed charts, summaries and schedules as necessary. - Assist with conferences and interviews of representatives of financial institutions, Certified Public Accountants, and other potential witnesses to financial activities. - Utilize electronic databases to identify assets, documents, and other physical evidence. - Analyze an individual or corporation’s ability to pay monetary penalties based on financial disclosures and independent investigation of assets and liabilities. - Perform ancillary investigation-related services in support of assigned cases as follows: - Develop, coordinate and issue draft technical audit guidelines and instructions applicable to financial audits and investigations. - Prepare interim and final reports throughout the investigation process for use by staff members. - Arrange for secure storage, preservation, organization and indexing of voluminous documentary evidence. - Assist in the compilation and analysis of documents and physical evidence, and the creation of charts, graphs, and other audio-visual materials for use in motions and at trial. - Meet with the designated federal agency personnel, state and local officials as needed throughout investigations. - Other related duties as assigned and within scope.x Qualifications: - Four-year undergraduate degree or higher in statistical/data analysis, finance, accounting, fraud examination, or other related field. - Minimum 3 years of professional work experience in finance, accounting, fraud examination or statistical/data analysis. - Proficient in Microsoft Office applications including Word, Excel, PowerPoint, Access, etc. - U.S. Citizenship and ability to obtain adjudication for the requisite background investigation. - Experience and expertise in performing the requisite services in Section 3 Preferred qualifications: - Experience reviewing and understanding medical records and knowledge of medical billing procedures, including experience using STARS and/or Business Objects. - Relevant experience working with a federal or state legal or law enforcement entity. Our Commitment: Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting-edge technology with world-class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems. For the past seven years, we’ve been growing our government-contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work. Here at CGS we value honesty through hard work and self-awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come. We care about our employees. Therefore, we offer a comprehensive benefits package. - Health, Dental, and Vision - Life Insurance - 401k - Flexible Spending Account (Health, Dependent Care, and Commuter) - Paid Time Off and Observance of State/Federal Holidays Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Join our team and become part of government innovation! Explore additional job opportunities with CGS on our Job Board: https://cgsfederal.com/join-our-team/ #CJ $50,000 - $100,000 a year We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
Role Description We are looking for an analytical and detail-oriented Internal Auditor to join our team. In this role, you will play a vital part in safeguarding the company's financial integrity by assessing internal controls, identifying risks, and ensuring compliance with policies and regulations. You will conduct audits, analyze financial data, and recommend process improvements that drive efficiency, accuracy, and transparency across the organization. - Conduct internal audits to evaluate financial and operational processes, ensuring compliance with company policies and regulatory requirements. - Analyze financial records, transactions, and supporting documents to identify discrepancies, inefficiencies, or risks. - Assess internal controls and recommend strategic improvements to enhance efficiency and mitigate risks. - Prepare detailed audit reports with clear findings and actionable recommendations for management. - Monitor the implementation of audit recommendations and track improvements over time. - Perform risk assessments and contribute to the development of robust audit plans. - Investigate fraud, anomalies, or policy violations and provide recommendations for corrective actions. - Conduct on-site audits, including store and inventory audits, cash handling reviews, and document verifications. - Collaborate with various departments to ensure financial and operational compliance. - Stay updated on accounting standards, tax regulations, and best practices in internal auditing. Qualifications - Bachelor's degree in Accountancy. - CPA license is a plus but not required. - At least 3 years of experience in internal audit. - Willing to conduct fieldwork and on-site audits as needed. - Strong understanding of accounting principles, financial reporting, and internal controls. - Proficient in MS Office (Excel) and Google Apps (Google Sheets) for data analysis and reporting. - Experience with ERP systems (e.g., Microsoft Dynamics) is an advantage. - Strong analytical, problem-solving, and critical-thinking skills. - Excellent attention to detail and ability to work independently. - Strong communication and interpersonal skills. - Ability to handle confidential information with the highest level of integrity and professionalism. Benefits - If you are passionate about auditing, risk assessment, and process optimization, and want to be part of a dynamic team that values integrity and excellence, apply now and take the next step in your career!
• Krijg jij energie van samenwerken met mensen • Vind je het interessant om bij diverse bedrijven een kijkje achter de schermen te nemen • Helpt de klant graag vooruit met zijn bedrijfsvoering • Zorgt dat certificatieschema’s worden onderhouden en uitgebreid • Voert audits uit voor managementschema’s in verschillende branches • Schrijft rapportages over bevindingen
IT Systems Auditor
ElectrosoftElectrosoft Services, Inc. is an award-winning company that provides comprehensive technology-based solutions and services to federal customers. While cybersecurity is our specialty, we also focus on ICAM, enterprise IT modernization, and software solutions. We always seek to delight our customers, so we retain highly qualified employees and offer them meaningful work, growth opportunities, and work-life balance. What sets us apart from all other contractors is the sense of teamwork our employees feel – and the knowledge that outstanding effort is recognized and rewarded. The camaraderie we share emanates from Lunch & Learn sessions where we explore new ideas together, fun group activities ranging from escape rooms to miniature golf, and much, much more. If we’ve described you and your dream workplace, please apply and share in the many benefits and opportunities we offer.
Role Description IT Systems Auditor demonstrates understanding of the Federal Financial Improvement Act (FFMIA) requirements and experience applying FFMIA requirements in assessment of financial systems. - Understanding of systems development phases and related work products, including requirements and design documentation. - Plans, executes, and reports on information systems controls assessments. - Understanding of GAO, the Federal Information Systems Controls Audit Manual and Federal Audit Manual approaches. - Ability to access information system controls in areas of Cybersecurity, access controls, change controls and segregation of duties. - Demonstrated experience in evaluating controls within ERP systems. - Provides summary reports and working papers with detailed results and actionable recommendations. Qualifications - At least 4 years of applicable financial or business experience, including at least 1 year of government experience. - Relevant 8140 certification from a nationally recognized authority. - Bachelor's Degree in relevant business or technical field. - Skilled in Microsoft Office programs (Excel, Word, PowerPoint, MS Project, etc.). - Excellent analytical and writing skills. - Familiarity with Federal Acquisition Regulations. - Knowledgeable in OMB Circulars A-123, A-127, A-134, and the Federal Information Systems Controls Audit Manual requirements. - Experience with Federal accounting principles: how to apply them in various accounting systems, how data can be captured and analyzed in various environments. - Experience with Defense Systems and Applications preferred. - Must be able to obtain or currently possess IT-II Non-Critical Sensitive security clearance or Tier 3 (T3). Requirements - At least 4 years of applicable financial or business experience, including at least 1 year of government experience. - Relevant 8140 certification from a nationally recognized authority. - Bachelor's Degree in relevant business or technical field. - Skilled in Microsoft Office programs (Excel, Word, PowerPoint, MS Project, etc.). - Excellent analytical and writing skills. - Familiarity with Federal Acquisition Regulations. - Knowledgeable in OMB Circulars A-123, A-127, A-134, and the Federal Information Systems Controls Audit Manual requirements. - Experience with Federal accounting principles: how to apply them in various accounting systems, how data can be captured and analyzed in various environments. - Experience with Defense Systems and Applications preferred. - Must be able to obtain or currently possess IT-II Non-Critical Sensitive security clearance or Tier 3 (T3). Benefits - Meaningful work and growth opportunities. - Work-life balance. - Teamwork and camaraderie through activities like Lunch & Learn sessions and group activities. Company Description Electrosoft Services, Inc. is an award-winning company that provides comprehensive technology-based solutions and services to federal customers. While cybersecurity is our specialty, we also focus on ICAM, enterprise IT modernization, and software solutions.
