Humana Medical Coding Consultant in Louisville, Kentucky

Role: Medical Coding Consultant Assignment: Humana Government Business Location: Forum 3, Louisville, KY

The Medical Coding Consultant conducts analysis of medical procedural claim coding to ensure that healthcare providers are accurately reimbursed for medical services rendered. Every medical service is assigned a numeric code to define diagnostics, treatments and procedures. It is the responsibility of the Coding Consultant to ensure the services billed represent accurate representation of service rendered. Accuracy of coding is vital to reimbursement; the Coding Consultant must have a strong understanding of (ICD-9, CPT & HCPCS) coding in addition to health insurance reimbursement policies and procedures.

KEY ACCOUNTABILITIES 40 % 1. Review and analyze claim coding utilizing knowledge of CPT-4 and HCPCS Level coding. Use findings for statistical analysis, data mining, and other proven analysis techniques. Verify analysis findings and provide results and recommendation to management. Develop and Implement innovative predictive modeling databases to optimize statistical /mathematical efficiency and quality. 30 % 2. Reviews billed services to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in claims payment policies. Utilizes extensive knowledge of medical terminology, ICD-9-CM, HCPCS Level II and CPT coding in conjunction with processing guidelines established thru CMS and Tricare coverage determinations. 15 % 3. Strong working knowledge of CPT-4, ICD-9 and HCPCS medical coding processes. Knowledge of medical coding software and understanding of claim audit procedures. Application of health insurance industry trends and best practices 15 % 4. Working knowledge of data analysis tools, such as SAS and database language tools like SQL. Ability to develop queries, generate reports and develop high level management presentations.

Role Essentials

  • Our Department of Defense contract requires U.S. Citizenship for this role

  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

  • Bachelor’s Degree in Business, Public Health, or related field (may substitute equivalent education and/or experience)

  • Three years’ experience in healthcare auditing and data analysis

  • Certified Coder (CPC, CCS or equivalent)

  • Understanding of medical insurance payment policies and reimbursement

  • Proficiency in Microsoft Access, Excel and Word

  • Understanding of auditing processes and procedures

  • Ability to speak effectively before groups of customers And employees of organization

  • High degree of self-awareness and emotional intelligence

Role Desirables

  • Experience and proficiency in Tableau or related statistical databases

  • Ability to read and interpret documents such as contracts and procedural manuals

Title: Medical Coding Consultant

Location: KY-Louisville

Requisition ID: 188884

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.