Senior Medical Coding Professional, Outpatient

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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. This role reports to the Manager, Payment Integrity.

Key responsibilities

• Research claims anomalies to identify outpatient audit opportunities
• Apply CPT/HCPCS coding guidelines and payer-specific rules
• Analyze how codes impact reimbursement, including APC grouping, edits, and 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

Additional information

• This is a remote work-at-home position
• Occasional travel to Humana offices for training or meetings may be required
• Scheduled weekly hours: 40
• This position is eligible for a bonus incentive plan