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Humana logo
Humana

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.

Medical Coding Auditor

AuditorAuditorFull TimeRemoteMid LevelTeam 10,001+Since 1961H1B SponsorCompany SiteLinkedIn

Location

United States + 1 moreAll locations: United States | Canada

Posted

78 days ago

Salary

$59.3K - $80.9K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Medical Coding Auditor

Humana

Become a part of our caring community and help us put health first Job Description Summary The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and coding for services rendered is complete, compliant, and accurate to support optimal reimbursement. You will report to the Supervisor, Payment Integrity. As the Nurse Auditor 2 you will - Validate and interpret medical documentation to ensure capture of all relevant coding. - Apply clinical and coding experience to conduct reviews of provider codes and billing - Focus on laboratory services and involve medical auditing of genetics, drug testing and infection agent testing claims that require interpretation and independent determination of the appropriate courses of action. - Reviews involve the review of Fraud Waste and abuse case determinations and require documentation and follow up regarding the result of these cases. Use your skills to make an impact Required Qualifications - Active RN license - Experience with outpatient CPT/HCPCS codes - Experience with review of medical records - 2+ years clinical experience - 3+ years' experience in the health industry Preferred Qualifications - Certified Professional Coder (CPC) - Familiar with lab or genetic testing - Fraud, Waste, and Abuse Investigative experience. - Clinical auditing experience - Bachelor's degree - Familiarity with CMS and Humana regulatory policies - Knowledge of general lab billing Additional Information WORK STYLE: Remote/work at home. WORK HOURS: Business hours are Monday-Friday, expected to work 8 hours/day, 5 days/week HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at Home To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. - Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. #LI-BB1 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: 04-17-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ 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.

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