Senior Medical Coding Professional, Outpatient

Humana

Senior Medical Coding Professional responsible for outpatient coding-focused audit activities. Ensuring compliance with outpatient coding and reimbursement guidelines while partnering with clinical and analytics teams.

Posted 7/31/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $71,100 - $97,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Expertise in CPT/HCPCS coding and outpatient audit processes, with a strong focus on analyzing claims anomalies and validating code assignments. Proven ability to collaborate with clinical and analytics teams to enhance audit strategies and support defensible audit determinations.

Highest-signal resume keywords

CPT/HCPCS CodingOutpatient Specialty Surgery ExperienceCPC CertificationClaims AnalysisRecord to Bill Review

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CPT CodingHCPCS CodingClaims Anomaly ResearchCode Assignment ValidationModifier UsageReimbursement AnalysisAudit DocumentationOperative Report CodingAPC GroupingBundling Edits

Certifications & Qualifications

CPCCOCCCSROCCRHIARHIT

Industry Keywords

Outpatient AuditAudit StrategiesRecovery RecommendationsEducation SupportPayer-Specific Rules

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

CPC, COC, CCS, ROCC, RHIA, or RHIT Certification
5+ years post certification experience with Outpatient Specialty Surgeries and Procedures
Knowledge of CPT/HCPCS coding
Experience reading and coding from operative reports

Benefits

Comp & perks

medical, dental and vision benefits
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 and many other opportunities