Medical Coding Auditor – Evaluation & Management

Humana

Medical Coding Auditor ensuring compliance and accuracy in coding Evaluation & Management services for Humana. Conducting audits and preparing reports, impacting healthcare quality effectively.

Posted 5/22/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $59,300 - $80,900 per yearWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

codingauditingprofessional fee codinginpatient E/Mminor proceduresemergency room servicesconsultation servicesannual wellness servicescode assignmentattention to detail

Soft Skills

analytical skillsorganizational skillscommunication skillsindependent workteam collaboration

Certifications

CPCCCS-PCPMACOC