Humana APC Outpatient Coding Auditor in Atlanta, Georgia

Role: APC Outpatient Coding Auditor Assignment: Provider Payment Integrity/Clinical Audit Location: Virtual

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule Be a part of the Provider Payment Integrity world-- Evaluate the business and system processes through the eyes of customers, members and provider partners leads to measurable improvements in cost, quality and speed to market.

Humana is seeking an Outpatient Coding Auditor specific to Ambulatory Payment Classification (APC) identify, collect, assess, monitor and document claims and encounter coding information. Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis and procedure codes based on services rendered. In this role you will: * Review medical record information to identify all appropriate coding specific to Ambulatory Payment Classification (APC)

  • Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.

  • Support and participate in process and quality improvement initiatives.

    Role Essentials

  • Certified Medical Coder with at least one of the following credentials: CPC, CCS, RHIA, RHIT

  • High school diploma

  • 3 years prior coding experience

  • Outpatient auditing experience

  • Experience reading operative reports

  • Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information

  • Ability to work independently and manage work load

  • Comfortable working in a production based work environment

  • Knowledge and experience in the health care environment/managed care

  • Strong written and verbal communication skills; strong analytical, organizational and time management skills

  • Strong knowledge of Microsoft Office products (Word, Excel)

  • Strong knowledge of CPT/HCPS coding

Role Desirables * 5 years prior coding experience

  • Ambulatory Payment Classification (APC)

  • Proven proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology and medicine

  • Strong knowledge of Microsoft Access

  • Experience in prospective payment methodologies

  • Strong knowledge of ICD-10 coding

  • 3M Coder/EncoderPro experience

  • Bachelor’s Degree 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.

    After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.

Title: APC Outpatient Coding Auditor

Location: KY-Louisville

Other Locations: US-IN-Indianapolis, US-WI-Green Bay, US-Texas-San Antonio, US-GA-Atlanta, US-North Carolina-Charlotte, US-OH-Cincinnati, US-Pennsylvania-Pittsburgh, US-FL-Tampa, US-South Carolina-Lancaster

Requisition ID: 181126

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.