Louisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to offer an integrated app
Medical Coding Auditor – Evaluation & Management
Location
United States
Posted
4 days ago
Salary
$59.3K - $80.9K / year
Seniority
Senior
Job Description
Medical Coding Auditor – Evaluation & Management
Humana
• Conduct comprehensive audits of professional evaluation and management services, inpatient, emergency room, minor procedures, consultation services, and annual wellness service encounters • Review and analyze provider documentation for completeness and accuracy to ensure proper code assignment in accordance with CPT, HCPCS, ICD-10-CM, and CMS guidelines • Utilize various encoders and coding tools/resources (e.g., decisionhealth, 3M, AMA, CMS) to validate code selection and support audit findings • Prepare detailed audit reports, summarizing findings, trends, and recommendations for education or process improvement • Remain current with changes in coding guidelines, payer policies, and industry trends impacting Evaluation & Management services • Assist with internal and external audit responses and appeals as needed • Support compliance initiatives and contribute to ongoing process improvement within the coding and auditing team
Job Requirements
- Current coding certification (e.g., CPC, CCS-P, CPMA, and/or COC)
- Minimum 3 years of recent experience in professional fee coding and auditing, with demonstrated expertise in inpatient E/M, minor procedures, emergency room, consultation, and annual wellness services
- Strong working knowledge of CPT, ICD-10-CM, HCPCS, CMS guidelines, and payer policies
- Proficient in the use of encoders and coding resources (such as 3M, Optum, AAPC, AMA)
- Excellent analytical, organizational, and communication skills
- Ability to work independently and collaboratively in a team environment
- Strong attention to detail
Benefits
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
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