DME/Outpatient Medical Coding Auditor

Medical Coding Auditor

Become a part of our caring community and help us put health first. Humana is looking for an experienced medical coding auditor to handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, consider a Fortune 100 company that prioritizes its consumers' and staff's well-being. This company rewards performance, and you should strongly consider the Outpatient Medical Coding Auditor position. This role focuses on Durable Medical Equipment (DME) auditing and is part of the PPI Coding Disputes Team with Humana. The Disputes Auditor DME Outpatient Coding on the Disputes Team reports to the Manager. This role consults and collaborates with coding professionals within and across departments. The goal is to ensure high accountability of coding disputes outcomes for timeliness, compliance, and quality.

This position requires:

• An experienced medical coding auditor with in-depth experience in outpatient DME coding disputes and expertise in CPT/HCPCS code assignments
• Ensuring overall accuracy and compliance of coding disputes reviews by adhering to all appropriate coding guidelines and communicating disputes outcomes to providers in a professional and concise manner
• Leveraging advanced auditing expertise to make coding decisions based on standard industry guidelines and best practices
• Managing multiple priorities, collaborating with peers and ensuring timely completion of outpatient coding disputes

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial securityboth today and in the future, including:

• 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

Use your skills to make an impact. Required qualifications include:

• CPC or CCS Certification
• CPT/HCPCS auditing experience
• 1+ years' work experience reading and interpreting claims
• 3+ years' experience performing DME coding audits in health insurance and/or hospital settings and working coding-related disputes and trending results
• Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Ability to work independently and determine appropriate course of action
• Excellent communication skills both written and verbal

Preferred qualifications include:

• Associate's Degree or higher in Health Information Management (HIM)
• Experience in Financial Recovery
• Experience in a fast paced, metric driven operational setting

Work-at-home requirements include:

• 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 includes using an interviewing technology called HireVue to enhance our hiring and decision-making ability. 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. This should take about 10-15 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to the next round.

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: $59,300 - $80,900 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Application deadline: 03-03-2026

About us: Humana Inc. (NYSE: HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal opportunity employer: It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.