Medical Coding Auditor

Where you come in 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. 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. Required Qualifications 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 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. Travel While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Some flexibility might be possible, depending on business needs. Pay Range $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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline 09-10-2026 About us 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 to 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. #J-18808-Ljbffr Humana Inc