[Hiring] Medical Coding Auditor Evaluation & Management @Humana

Role Description

The Evaluation & Management Auditor (Medical Coding Auditor) is responsible for the accurate and compliant review of Evaluation and Management services, including:

• Complex professional inpatient encounters
• Minor procedures
• Emergency room services
• Consultation services
• Annual wellness visits

This role ensures correct documentation, coding, and billing in accordance with regulatory guidelines, payer policies, and Humana’s internal standards. The Medical Coding Auditor Evaluation & Management will report to the Manager, Medical Coding.

Qualifications

• Current coding certification (e.g., CPC, CCS-P, CPMA, and/or COC)
• Minimum 3 years of recent experience in professional fee coding and auditing
• 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

Requirements

• 5 years post-certification experience auditing professional evaluation & management services - with a strong focus on professional fee inpatient services
• Experience with electronic health records (EHR) and coding audit software
• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Experience in a managed care, payer, or large multi-specialty health system setting

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