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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.
WORK STYLE
Remote / Work at home
WORK HOURS
Associates will work on EST, regardless of where the associate resides. All associates must start between 6 AM‑9 AM 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.
Use your skills to make an impact
Eager to apply your coding expertise to enhance financial stewardship and quality of care through meticulous audit and compliance work.
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.
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
Work At Home / Internet Information
Internet speed: download 25 Mbps, upload 10 Mbps; recommendation: wireless, wired cable or DSL connection.
Satellite, cellular and microwave connections are allowed only with leadership approval.
Employees in California, Illinois, Montana, or South Dakota will receive a bi‑weekly payment for internet expense.
Humana will provide telephone equipment as required.
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.
Compensation
Pay Range: $59,300 - $80,900 per year
This job is eligible for a bonus incentive plan based upon company and/or individual performance.
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our accessibility resources at https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
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