Senior Medical Coding Auditor
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior outpatient medical coding auditor reviewing claims, coding accuracy, and reimbursement compliance for Humana’s healthcare services. Supporting recovery, education, and payment-integrity strategies.
Responsibilities:
- Research claims anomalies to identify outpatient audit opportunities
- Apply CPT/HCPCS coding guidelines and payer-specific rules
- Analyze how codes impact reimbursement, including APC grouping, edits, and 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
- Report to the Manager, Payment Integrity
- Occasionally travel to Humana offices for training or meetings
Requirements:
- 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: 5+ years prior coding experience
- Preferred: Outpatient facility auditing experience
- Preferred: Experience with outpatient data trends
- Preferred: Ambulatory Payment Classification (APC) coding experience
- Preferred: Experience in prospective payment methodologies
- Preferred: 3M Coding software experience
- Preferred: Radiation Oncology coding experience
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect 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 smart healthcare decision support
- Remote work arrangement
- Self-provided internet service for home work
Similar Jobs
Medical Coder
Medical Coder supporting RELI Group’s government healthcare audits through accurate Medicare Part C and risk-adjustment record coding. Maintaining high accuracy, productivity, and PHI confidentiality.
Senior Medical Coding Specialist
Senior Medical Coding Specialist leading clinical-trial medical coding at ICON, a global healthcare intelligence and research organization. Ensuring accurate, compliant data using MedDRA and WHO Drug Dictionary.
Coding Specialist III – Clinical Practice Services
Coding Specialist III managing CPT/ICD-10-CM coding, charge processing, and reimbursement issues for Medical College of Wisconsin. Supporting clinical departments, provider education, and billing accuracy remotely within Wisconsin.
OBGYN Medical Coder
OBGYN medical coder reviewing records and assigning ICD-10-CM and CPT-4 codes for U.S. healthcare clients. Supporting clinic, surgery, and professional fee/facility coding remotely.
OBGYN Medical Coder
OBGYN medical coder supporting U.S. healthcare systems with professional fee and facility clinic and surgery coding. Reviewing records, abstracting data, and assigning ICD-10-CM and CPT-4 codes.
Medical Coding, Reimbursement Specialist
Medical coding specialist supporting Guidehouse’s federal healthcare consulting programs. Developing and validating code sets, reimbursement rules, and claims-related workflows across clinical and analytics stakeholders.
Medical Coding and Reimbursement Specialist
Medical coding specialist supporting Guidehouse’s federal healthcare programs. Developing and validating code sets, reimbursement rules, and claims operations with clinical and analytics teams.
Surgery Coding Specialist
Outpatient surgery coding specialist reviewing clinical documentation and assigning ICD-10, CPT, and HCPCS codes. Supporting TEKsystems’ hospital coding services through Epic workflows and compliance standards.
Outpatient Profee Coder
Remote part-time outpatient profee coder abstracting physician services and diagnoses for Infinx, a healthcare revenue-cycle technology company. Correcting claims, applying ICD-10 coding, and supporting reimbursement accuracy for healthcare providers.
Coder – Inpatient
Inpatient medical coder assigning ICD-10-CM and ICD-10-PCS codes for Children’s pediatric hospital encounters. Reviewing records, abstracting data, and resolving missing documentation.
Cardiology Medical Coder
Remote Profee Cardiology Medical Coder supporting IKS Health’s medical-record coding services. Reviewing physician records and assigning cardiac diagnoses and procedures using ICD-10-CM and CPT.
Cardiology Medical Coder
Remote Profee Cardiology Medical Coder supporting IKS Health’s outpatient and physician-record coding services. Assigning ICD-10-CM and CPT codes, abstracting records, and mentoring coding staff.
Medical Billing Manager
Medical Billing Manager scaling multi-state billing for Abby Care’s AI-powered family-care platform. Leading claims optimization, compliance, SOP creation, and revenue collection.
Home Health Medical Billing Specialist
Home health medical billing specialist supporting Abby Care’s AI-powered family caregiving platform. Preparing high-volume insurance claims and validating aide hours for accurate payroll and billing.
Radiation Oncology Coder, Outpatient Specialty
Radiation oncology coder assigning ICD-10 and CPT codes for Sutter Health outpatient specialty services. Abstracting records, resolving billing edits, and supporting compliant claims processing.
Certified Professional Coder
Certified Professional Coder assigning ICD-10-CM and CPT-4 codes for Logan Health’s Montana healthcare system. Abstracting clinical data and supporting accurate billing, reimbursement, and compliance.
Medical Coder
Medical Coder supporting Mercy Urgent Care’s patient care through accurate visit coding and insurance billing. Handling claims, payments, denials, appeals, and patient phone inquiries remotely.
Medical Billing and Payment Specialist
Medical billing specialist posting insurance payments, denials, and adjustments for MedCentris’ healthcare practice. Reconciling payment batches, resolving payer issues, and maintaining accurate patient accounts.
Medical Coding Quality Analyst
Medical Coding Quality Analyst auditing and educating coders for Lifepoint Health’s community-based healthcare network. Ensuring accurate coding, documentation compliance and client-specific billing standards.
Coder – Inpatient
Coder providing accurate ICD-10 coding for inpatient encounters in a leading children's hospital. Join us in making a difference in kids' health outcomes.