Inpatient Medical Coding Quality Auditor

Join our compassionate community and help us prioritize health! The Inpatient Medical Coding Quality Auditor is responsible for meticulously extracting clinical information from a variety of medical records, assigning correct procedural terminology and medical codes (such as ICD-10-CM, CPT) to patient records. This role involves engaging with moderately complex to complex issues where detailed evaluation of variable factors is essential. At Humana, we seek an experienced medical coding auditor motivated to review inpatient hospital claims to ensure proper reimbursement and effectively manage provider disputes in a results-oriented, metrics-driven environment. If you are eager to work from home for a leading Fortune 100 company that values the well-being of its consumers and employees while rewarding performance, we encourage you to explore the Inpatient Coding Auditor (MS-DRG) position. The Inpatient Medical Coding Quality Auditor plays a vital role in cost reduction efforts by enhancing the accuracy of provider contract payments in our payer systems. You will ensure correct claims payment and appropriate diagnosis-related group (DRG) assignments. Responsibilities include analyzing, entering, and manipulating databases, as well as responding to internal medical information requests. You'll need to understand departmental and organizational strategies, make informed decisions about your work approach, and frequently navigate ambiguous situations with minimal guidance while adhering to established guidelines and procedures. Utilize your skills to drive impact! WORK STYLE: Remote work from home. Please note that 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, between 6 AM and 6 PM. Some flexibility might be available depending on business needs. Required Qualifications | What it takes to Succeed: RHIA, RHIT or CCS Certification (held for at least 4 years) Experience with MS-DRG coding/auditing Proficient in reading and interpreting claims Experience in conducting inpatient coding reviews/audits in health insurance or hospital settings Working knowledge of Microsoft Office Suite including Word, PowerPoint, and Excel Strong attention to detail Ability to work independently and determine the best course of action Capacity to handle multiple priorities Commitment to maintaining confidentiality Exceptional written and verbal communication skills Preferred Qualifications: Experience in APR DRG coding/auditing Familiarity with Financial Recovery Proven experience in a fast-paced, metrics-driven operational setting Additional Information: Work at Home Requirements: Minimum download speed of 25 Mbps and upload speed of 10 Mbps; recommended connection types include wired cable or DSL Satellite, cellular, and microwave connections may be used only if approved by leadership Associates working from home in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense reimbursement. Humana will provide necessary telephone equipment to meet job requirements. A dedicated workspace free from interruptions is necessary to safeguard member PHI/HIPAA information. Interview Format: The hiring process will include the use of Hire Vue technology for quick and effective assessment of your skills and experience. If you are selected to continue after the initial application screening, you will receive an invitation to partake in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. The pre-recorded interview will entail responding to questions via your phone and will take around 10-15 minutes. If you participate in an SMS Text interview, you will respond to questions through your cell phone or computer. This interview will last approximately 5-10 minutes. Your recorded responses will be reviewed for further progression in the interview process. Travel: This is a remote position, but occasional travel to Humana's offices for training or meetings may be necessary. Scheduled Weekly Hours: 40 Compensation Range: We offer a competitive salary based on location and individual qualifications, with a projected yearly salary of $71,100 - $97,800 for full-time employment (40 hours per week). This position also qualifies for a bonus incentive plan based on individual and company performance. Benefits Overview: Humana, Inc. provides comprehensive benefits supporting holistic well-being. Our benefits inspire personal wellness and smart healthcare decisions for you and your family, alongside recognizing life outside of work. We offer medical, dental, and vision coverage, a 401(k) retirement plan, various forms of paid leave, short-term and long-term disability, life insurance, and many more opportunities. Application Deadline: 12-31-2029 About Us: Humana Inc. (NYSE: HUM) is dedicated to prioritizing health for our teammates, customers, and the organization as a whole. Through our insurance and healthcare services, we strive to enable millions to achieve better health, providing the care and support they require, when they need it. Our efforts are contributing to enhanced quality of life for individuals with Medicare, Medicaid, families, individuals, military personnel, and broader communities. Equal Opportunity Employer: Humana is committed to fair employment practices and prohibits discrimination against any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We actively seek to employ and advance individuals with disabilities or protected veteran status, basing all employment decisions on valid job requirements and affirmative action. Humana adheres to all relevant federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. We also provide assistance with language services as needed.

Created: 2026-03-04