Humana Inc
Become a part of our caring community and help us put health first
The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and ensuring correct claims payment for appropriate CPT/HCPCS code assignments. The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy and operating objectives, and follows established guidelines and procedures while making decisions in ambiguous situations.
Where you come in The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing accuracy of provider contract payments and ensuring correct claims payment for appropriate CPT/HCPCS code assignments. The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy, operating objectives, and follows established guidelines and procedures.
As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will:
Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered.
Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding.
Utilize encoders and various coding resources.
Perform CPT/HCPCS procedure reviews.
Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed.
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 guidelines, government regulation and protocols.
Complete appropriate system entries regarding claim/encounter information.
Support and participate in process and quality improvement initiatives.
What Humana offers We offer remote work. As a Fortune 100 Company, we value associate engagement and well‑being, and provide excellent professional development & continued education.
Use your skills to make an impact WORK STYLE 100% work at home / remote.
WORK HOURS Typical business hours are Monday‑Friday, 8 hours/day, 5 days/week – some flexibility may be possible depending on business needs.
Required qualifications – what it takes to succeed
Minimum of 3 years post‑certification experience and certification with CPC, COC, CCS, ROCC, RHIA or RHIT.
Experience with outpatient specialty surgeries and procedures.
Strong knowledge of CPT/HCPCS coding.
Experience reading & coding from operative reports.
Chemotherapy/therapeutic infusion experience.
Solid judgment and discretion in handling and disseminating information.
Strong attention to detail, ability to work independently and handle multiple priorities.
Comfortable working in a production‑based work environment.
Strong written and verbal communication skills; strong analytical, organizational and time‑management skills.
Working knowledge of Microsoft Office (Word, Excel).
Preferred qualifications
5+ years prior coding experience.
Minimum of 3 years post‑certification experience reading and interpreting claims.
Outpatient facility auditing experience.
Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology.
Ambulatory Payment Classification (APC) coding experience.
Radiation Oncology coding experience.
Experience in prospective payment methodologies.
Experience with the Claims Life Cycle including Accounts Receivable.
3M Coder software experience.
Additional information Work at home requirements
Minimum download speed: 25 Mbps; upload speed: 10 Mbps.
Wireless, wired cable or DSL connection is suggested.
Satellite, cellular, and microwave connection may be used only if approved by leadership.
Associates in California, Illinois, Montana, or South Dakota receive bi‑weekly payment for internet expense.
Humana will provide telephone equipment appropriate to meet business requirements for Home or Hybrid Home/Office associates.
Dedicated work space without interruptions to protect PHI/HIPAA information.
Interview format Our hiring process uses Hire Vue (formerly Modern Hire). If selected, you will receive invites for a pre‑recorded voice interview and/or SMS Text Messaging interview of approximately 10‑15 minutes or 5‑10 minutes, respectively.
Travel Occasional travel to Humana 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 job‑related skills, knowledge, experience, education, certifications, etc.
$59,300 – $80,900 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.
Description of benefits Humana offers competitive benefits supporting whole‑person well‑being. Benefits include medical, dental, vision coverage, a 401(k) plan, paid time off (including holidays and volunteer time), paid parental and caregiver leave, short‑term and long‑term disability, life insurance and more.
Application Deadline: 01-12-2026
About us Humana Inc. (NYSE: HUM) is committed to putting health first – for teammates, customers and the company. Through Humana insurance services and CenterWell, we help people achieve better health, delivering care when needed, improving quality of life for Medicare, Medicaid, families, individuals, military service personnel and communities.
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. Humana also adopts affirmative action in compliance with Section 503 of the Rehabilitation Act and VEVRAA, employing and advancing individuals with disability or protected veteran status, and basing employment decisions on valid job requirements. This policy applies to all employment actions, including recruitment, hiring, promotion, transfer, demotion, layoff, recall, termination, pay, training and apprenticeship at all levels.
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.
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Where you come in The Medical Coding Auditor reviews medical claims submitted against medical records to ensure correct coding guidelines are met (e.g., ICD‑10‑CM, CPT, HCPCS). The role requires interpretation and independent determination of the appropriate courses of action, contributing to overall cost reduction by increasing accuracy of provider contract payments and ensuring correct claims payment for appropriate CPT/HCPCS code assignments. The Auditor analyzes, enters and manipulates database data, responds to or clarifies internal requests for medical information, understands departmental, segment and organizational strategy, operating objectives, and follows established guidelines and procedures.
As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will:
Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered.
Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Hospital Outpatient Facility coding.
Utilize encoders and various coding resources.
Perform CPT/HCPCS procedure reviews.
Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed.
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 guidelines, government regulation and protocols.
Complete appropriate system entries regarding claim/encounter information.
Support and participate in process and quality improvement initiatives.
What Humana offers We offer remote work. As a Fortune 100 Company, we value associate engagement and well‑being, and provide excellent professional development & continued education.
Use your skills to make an impact WORK STYLE 100% work at home / remote.
WORK HOURS Typical business hours are Monday‑Friday, 8 hours/day, 5 days/week – some flexibility may be possible depending on business needs.
Required qualifications – what it takes to succeed
Minimum of 3 years post‑certification experience and certification with CPC, COC, CCS, ROCC, RHIA or RHIT.
Experience with outpatient specialty surgeries and procedures.
Strong knowledge of CPT/HCPCS coding.
Experience reading & coding from operative reports.
Chemotherapy/therapeutic infusion experience.
Solid judgment and discretion in handling and disseminating information.
Strong attention to detail, ability to work independently and handle multiple priorities.
Comfortable working in a production‑based work environment.
Strong written and verbal communication skills; strong analytical, organizational and time‑management skills.
Working knowledge of Microsoft Office (Word, Excel).
Preferred qualifications
5+ years prior coding experience.
Minimum of 3 years post‑certification experience reading and interpreting claims.
Outpatient facility auditing experience.
Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology.
Ambulatory Payment Classification (APC) coding experience.
Radiation Oncology coding experience.
Experience in prospective payment methodologies.
Experience with the Claims Life Cycle including Accounts Receivable.
3M Coder software experience.
Additional information Work at home requirements
Minimum download speed: 25 Mbps; upload speed: 10 Mbps.
Wireless, wired cable or DSL connection is suggested.
Satellite, cellular, and microwave connection may be used only if approved by leadership.
Associates in California, Illinois, Montana, or South Dakota receive bi‑weekly payment for internet expense.
Humana will provide telephone equipment appropriate to meet business requirements for Home or Hybrid Home/Office associates.
Dedicated work space without interruptions to protect PHI/HIPAA information.
Interview format Our hiring process uses Hire Vue (formerly Modern Hire). If selected, you will receive invites for a pre‑recorded voice interview and/or SMS Text Messaging interview of approximately 10‑15 minutes or 5‑10 minutes, respectively.
Travel Occasional travel to Humana 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 job‑related skills, knowledge, experience, education, certifications, etc.
$59,300 – $80,900 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.
Description of benefits Humana offers competitive benefits supporting whole‑person well‑being. Benefits include medical, dental, vision coverage, a 401(k) plan, paid time off (including holidays and volunteer time), paid parental and caregiver leave, short‑term and long‑term disability, life insurance and more.
Application Deadline: 01-12-2026
About us Humana Inc. (NYSE: HUM) is committed to putting health first – for teammates, customers and the company. Through Humana insurance services and CenterWell, we help people achieve better health, delivering care when needed, improving quality of life for Medicare, Medicaid, families, individuals, military service personnel and communities.
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. Humana also adopts affirmative action in compliance with Section 503 of the Rehabilitation Act and VEVRAA, employing and advancing individuals with disability or protected veteran status, and basing employment decisions on valid job requirements. This policy applies to all employment actions, including recruitment, hiring, promotion, transfer, demotion, layoff, recall, termination, pay, training and apprenticeship at all levels.
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.
#J-18808-Ljbffr