Senior Medical Coding Auditor

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $71.1k - $97.8k / year

⏰ Full Time

🟠 Senior

🏥 Medical Billing and Coding

🦅 H1B Visa Sponsor

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• 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