Senior Medical Coding Professional, Outpatient

Become a part of our caring community   The Senior Medical Coding Professional, Outpatient 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.

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 Use your skills to make an impact   Required Qualifications 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 Preferred Qualifications 5+ years prior coding experience Outpatient facility auditing experience Ambulatory Payment Classification (APC) coding experience Experience in prospective payment methodologies 3M Coding software experience Radiation Oncology coding experience Additional Information Work-At-Home Requirements To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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 associates 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 Our Hiring Process As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round. #LI-LM1 Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   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