Senior Medical Coding Professional, Outpatient
About the role
The Senior Medical Coding Professional, Outpatient 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.
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
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
- Experience reading and coding from operative reports
Preferred Qualifications
- 5+ years prior coding experience
- Outpatient facility auditing experience
- Ambulatory Payment Classification (APC) coding experience
- Experience in prospective payment methodologies
- 3M Coding software experience
- Radiation Oncology coding experience
Pay
$71,100 - $97,800 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.
Benefits
Humana offers 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.
Schedule
40 hours per week. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
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 connection can be used only if approved by leadership.
- Employees 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.
Our Hiring Process
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue. If selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and will provide responses to each question, taking about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.