Medical Coding Auditor

About the role

The Medical Coder extracts clinical information from medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. This role involves advanced and highly specialized administrative, operational, and customer support duties requiring independent initiative and judgment. The Medical Coding Auditor confirms correct CPT coding assignments, analyzes and manipulates databases, and responds to internal requests for medical information. You will review medical documentation for clinical indicators to ensure correct coding guidelines are met and perform CPT/HCPCS code reviews for professional Evaluation and Management services across various settings.

Responsibilities

• Perform CPT/HCPCS code reviews for professional Evaluation and Management services: Inpatient, Office, ER, Telehealth, Home Health, Behavioral health, and/or minor procedures.
• Maintain productivity and quality metrics.
• Utilize encoders and various coding resources.
• Maintain current working knowledge of ICD-10 and CPT coding principles, government regulations, and protocols.
• Maintain strict patient and physician confidentiality.
• Understand department, segment, and organizational strategy and operating objectives.
• Make decisions regarding own work methods, occasionally in ambiguous situations, with minimal direction.

Requirements

• CPC, CCS, COC, RHIA, or RHIT Certification through AAPC or AHIMA.
• Minimum of 3 years post-certification experience auditing Professional Evaluation & Management (E&M) Services in settings such as Inpatient, Office, ER, Telehealth, Home Health, Behavioral health, and/or minor procedures.
• Working knowledge of Microsoft Office Programs (Word, PowerPoint, and Excel).
• Ability to work independently and determine appropriate courses of action.

Preferred Qualifications

• Bachelor’s Degree.
• 3 or more years of experience as a certified medical coder.

Work Style

This is a remote, work-at-home position. While primarily remote, occasional travel to Humana's offices for training or meetings may be required. Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. After training, associates may start as early as 6 AM in their own time zone, depending on business needs.

Work at Home Requirements

• 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. Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Associates in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses.
• Humana provides telephone equipment appropriate to meet business requirements.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Pay

The pay range for this full-time (40 hours per week) position is $53,100 - $72,500 per year. The range may be higher or lower based on geographic location, and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, and certifications.

Benefits

Humana offers competitive benefits designed to support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.