Medical Coding Auditor

Humana • Providence, RI • 7h ago

Become a part of our caring community

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

Use your skills to make an impact

Required Qualifications

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

Preferred Qualifications

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

Additional Information

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.

Scheduled Weekly Hours

Pay Range

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.

Description of Benefits

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.

Application Deadline: 04-10-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell 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 at large. Learn more about what we offer at?Humana.com?and at?CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Humana

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