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The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records.
The Medical Coding Auditor audits medical charts and records for compliance with federal coding regulations. provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements.
Essential Functions
You will verify and ensure the accuracy, completeness, specificity, and appropriateness of medical record documentation based on a patient's documented medical conditions
You will confirm appropriate diagnosis and procedure code assignment, following all applicable coding guidelines
You will use electronic tools (i.e., spreadsheets-web-based) that have been created based on the CMS-HCC model and established coding guidelines
You will prepare written summaries of audit findings
You will present verbal audit feedback and provide education upon completion of the medical record audit
You will pespond to or clarify internal requests for information
You will support and participate in process and quality improvement projects
You will partner with business associates from other departments to understand their needs and concerns, and help develop system solutions
You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
You will makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed.
You will follow established guidelines/procedures
You will help code capacities
Use your skills to make an impact
Required Qualifications
This position requires both a CPMA AND CRC and it also requires at least ONE of the certifications from AAPC or AHIMA from the list below:
CPC - Certified Professional Coder (AAPC)
CCS - Certified Coding Specialist (AHIMA)
CCS-P - Certified Coding Specialist-Physician Based (AHIMA)
2 or more years of outpatient coding experience (Preferably in a risk adjustment setting)
Knowledge of several reimbursement methodologies, including risk adjustment and fee for service
Must maintain annual continuing education requirements and remain in good standing with the certification governing body
Will work in a goal-oriented environment that is production and quality driven
Passionate about contributing to an organization focused on continuous improvement
Proficient in all Microsoft Office applications, including Word and Excel
Public speaking / group presentation skills
Ability to travel locally and overnight within Conviva and CenterWell markets per business need
Preferred Qualifications
CDEO
Bachelor's Degree
Experience with Athena and eCW (Electronic Medical Records)
Outpatient auditing experience, preferably in a risk adjustment setting
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
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: 06-30-2026
About us
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana's Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at?CenterWell.com.
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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.
Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options https://www.partnersinprimarycare.com/accessibility-resources
