Certified Senior Medical Coding Outpatient Auditor

Humana

5d • $71,100 - $97,800 • Remote

About The Position

The Senior Medical Coding Outpatient Auditor is responsible for coding-focused audit activities, including identifying billing anomalies, validating coding accuracy, and ensuring compliance with outpatient coding and reimbursement guidelines. You will report to the Manager, Payment Integrity.

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

Nice To Haves

• 5+ years prior coding experience
• Outpatient facility auditing experience
• Experience with outpatient data trends
• Ambulatory Payment Classification (APC) coding experience
• Experience in prospective payment methodologies
• 3M Coding software experience
• Radiation Oncology coding experience

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

Benefits

• medical
• dental
• vision
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed