Medical Coding Auditor Evaluation & Management

Evaluation & Management Auditor (Medical Coding Auditor)

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, and annual wellness visits. The ideal candidate will have a strong background in professional fee coding and auditing, expertise in industry-standard encoders, and familiarity with multiple coding resources. 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.

Work Style: Remote/Work at home

Work Hours: Associates will work on EST, regardless of where the associate resides. All associates must start between 6AM-9AM EST, Monday – Friday as a dedicated schedule. Work hours can vary occasionally and/or depending on business needs.

Responsibilities:

• Conduct comprehensive audits of professional evaluation and management services, inpatient, emergency room, minor procedures, consultation services, and annual wellness service encounters.
• Review and analyze provider documentation for completeness and accuracy to ensure proper code assignment in accordance with CPT, HCPCS, ICD-10-CM, and CMS guidelines.
• Utilize various encoders and coding tools/resources (e.g., decisionhealth, 3M, AMA, CMS) to validate code selection and support audit findings.
• Prepare detailed audit reports, summarizing findings, trends, and recommendations for education or process improvement.
• Remain current with changes in coding guidelines, payer policies, and industry trends impacting Evaluation & Management services.
• Assist with internal and external audit responses and appeals as needed.
• Support compliance initiatives and contribute to ongoing process improvement within the coding and auditing team.

Required 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, with 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

Preferred Qualifications

• 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.

Additional Information

Work Style: Remote/Work at home

Work Hours: Associates will work on EST, regardless of where the associate resides. All associates must start between 6AM-9AM EST, Monday – Friday as a dedicated schedule. Work hours can vary occasionally and/or depending on business needs.

Benefits Information:

• 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

Work At Home / Internet Information:

• 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 employees 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.

SSN Alert:

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.

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 be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$59,300 - $80,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 05-28-2026

About Us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

​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. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.