Medical Coding Auditor

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The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met. The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Medical Coding Auditor confirms correct CPT coding assignments. Analyzes, enters and manipulates the claim in the respective database. Responds to or clarifies internal requests for medical information. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

• Review medical documentation for clinical indicators to ensure procedures meet clinical criteria and correct coding guidelines
• Utilize encoders and various coding resources
• Perform CPT Procedure reviews
• 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 principles, government regulation, protocols

• Minimum of 3+ years post certification experience Outpatient Specialty Surgeries and Procedures for Physicians
• RHIA, RHIT, CCS, CPC, or COC Certification
• Strong knowledge of NCD/LCDs, CMS Manual, NCCI Edits, and coding guidelines
• Experience reading & coding from operative reports
• 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

• STRONGLY PREFERRED :
  Experience with coding/auditing multispecialty surgical procedures.
• Experience with coding/auditing Professional Inpatient Claims
• Experience in Select Coder, 3M
• Experience with the Claims Life Cycle

WORK STYLE:
Remote/Work at home; minimal travel may be required for onsite meetings.

WORK HOURS:

Associates will work on EST, regardless of where the associate resides. Work hours can vary, slightly, but all associates start between 6AM-9AM EST. Some flexibility is available, depending on business needs.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

40

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.

$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.

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Final date to receive applications: 04-10-2026

About Humana:
Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our Center Well 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 rn more about what we offer at Humana.comand