Senior Medical Coding Auditor

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate claims discrepancies to uncover outpatient audit potentials

• Implement CPT/HCPCS coding standards and payer-specific guidelines

• Evaluate the impact of coding on reimbursement, including APC classification, edits, and bundling

• Perform thorough record-to-bill assessments

• Confirm correct code assignment and modifier application

• Record findings and support substantiated audit conclusions

• Offer suggestions for recovery or educational initiatives

• Collaborate with clinical and analytics teams on audit tactics

• Report to the Manager of Payment Integrity

• Occasionally travel to Humana offices for training sessions or meetings

⛳️ Requirements

• CPC, COC, CCS, ROCC, RHIA, or RHIT certification

• A minimum of 5 years of post-certification experience in Outpatient Specialty Surgeries and Procedures

• Solid understanding of CPT/HCPCS coding

• Experience in auditing

• Proficient in reading and coding from operative reports

• Preferred: Over 5 years of previous coding experience

• Preferred: Experience in outpatient facility auditing

• Preferred: Familiarity with outpatient data trends

• Preferred: Knowledge of Ambulatory Payment Classification (APC) coding

• Preferred: Experience in prospective payment models

• Preferred: Familiarity with 3M Coding software

• Preferred: Experience in Radiation Oncology coding

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload

• A dedicated workspace free from interruptions to safeguard member PHI/HIPAA information

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance

• Medical, dental, and vision benefits

• 401(k) retirement savings plan

• Paid time off

• Company holidays

• Personal holidays

• Paid parental leave

• Paid caregiver leave

• Short-term disability

• Long-term disability

• Life insurance

• Personal wellness and intelligent healthcare decision support

• Remote work option

• Self-provided internet service for home-based work