Certified Senior Medical Coding Outpatient Auditor

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The Senior Medical Coding Outpatient Auditor is responsible for coding-focused audit activities, including identifying billing anomalies, validating coding accuracy, and ensuring compliance with outpatient coding and reimbursement guidelines. You will report to the Manager, Payment Integrity.

Key Responsibilities

• Research claims anomalies to identify outpatient audit opportunities
• Apply CPT/HCPCS coding guidelines and payer-specific rules
• Analyze how codes impact reimbursement (APC grouping, edits, bundling)
• Conduct detailed record to bill reviews
• Validate appropriate code assignment and modifier usage
• Document findings and support defensible audit determinations
• Provide recommendations for recovery or education
• Partner with clinical and analytics teams on audit strategies

Use your skills to make an impact

Required Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT Certification
• 5+ years post certification experience with Outpatient Specialty Surgeries and Procedures
• Knowledge of CPT/HCPCS coding
• Audit experience
• Experience reading and coding from operative reports

Preferred Qualifications

• 5+ years prior coding experience
• Outpatient facility auditing experience
• Experience with outpatient data trends
• Ambulatory Payment Classification (APC) coding experience
• Experience in prospective payment methodologies
• 3M Coding software experience
• Radiation Oncology coding experience

Additional Information

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$71,100 - $97,800 per yearThis 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: 08-26-2026

About us

About Humana: 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, 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.

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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.