Senior Outpatient Coding Auditor (Remote)

Humana; United States; On-site; USD 71,000 - 98,000; Full time

Benefits offered by this job

Medical benefits

401(k) retirement savings plan

Paid time off

Job summary

Humana is seeking a Senior Medical Coding Outpatient Auditor to lead coding-focused audit activities and ensure compliance with outpatient coding and reimbursement guidelines. You will report to the Manager, Payment Integrity and collaborate with clinical and analytics teams to improve audit outcomes.

The role requires CPC/COC/CCS/ROCC/RHIA/RHIT certification, 5+ years of post-certification outpatient auditing experience, and proficiency in CPT/HCPCS coding.

Qualifications

• Must have active in-field auditing and outpatient coding experience.
• Strong knowledge of CPT/HCPCS coding rules and payer guidelines.
• Experience reading operative reports and applying coding to surgical procedures.

Responsibilities

• Research claims anomalies to identify outpatient audit opportunities.
• Apply CPT/HCPCS coding guidelines and payer-specific rules.
• Analyze how codes impact reimbursement (APC grouping, edits, 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.

Skills

Audit experience

CPT/HCPCS knowledge

Outpatient coding

Education

CPC, COC, CCS, ROCC, RHIA, or RHIT Certification

RHIT Certification

RHIA Certification

Tools

3M Coding software

Job description

Humana is seeking a Senior Medical Coding Outpatient Auditor to lead coding-focused audit activities and ensure compliance with outpatient coding and reimbursement guidelines. You will report to the Manager, Payment Integrity and collaborate with clinical and analytics teams to improve audit outcomes.

The role requires CPC/COC/CCS/ROCC/RHIA/RHIT certification, 5+ years of post-certification outpatient auditing experience, and proficiency in CPT/HCPCS coding.