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Job Description
The DRG Validation Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (eg, ICD-10-CM and PCS) 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 DRG Validation Auditor confirms appropriate diagnosis related group (DRG) 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. 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 5% or less of the work year for training, team meetings, possible onsite audits opportunities and implementation needs.
Required Qualifications* + RHIA, RHIT, CCS Certification(s) + Experience with MS-DRG auditing or APR auditing experience + Acute in-patient coding experience + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Ability to travel 5% or less of the work year for training, team meetings, possible onsite audits opportunities and implementation needs.Work-At-Home Requirements*. WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office.
Associates or contractors who live and work from home in the state of California will be provided payment for their Internet expense A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required Satellite and Wireless Internet service is NOT allowed for this role A dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.COVID Vaccination Policy*. For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work.
The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. If progressed to offer, you will be required to:. Provide proof of full vaccination, including booster,?or commit to testing protocols OR?.
Provide proof of applicable exemption including any required supporting documentation. Medical, religious, state and remote-only work exemptions are available Preferred Qualifications* + Bachelor’s degree As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. 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 for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses or text to each question. You should anticipate this interview to take about 15 to 30 minutes.
Your recorded/text interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews Scheduled Weekly Hours* 40.
