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Humana Medical Coding Auditor - Remote, nationwide in Bethesda, Maryland



The SIU and PPI Lab review team is seeking a Medical Coding Auditor with a special set of skills. This person will focus on coding and clinical review of therapy claims: Physical, Speech, Occupational, and Chiropractic claims. This individual will not only review information provided in the medical records they must understand what each line of business allows and restricts as appropriate and have an in depth knowledge of the therapy codes, definitions, what the codes represents and how it should represented in the records.

The ideal candidate will be an avid learning; with excellent research skills able to verbally communicate why a code is not meeting certain standards and what should be added to make the records whole. In addition this person will be able to articulate this information confidently to other medical and lay professionals both internal and external to Humana professionals

The Medical Coding Auditor in this situation must analyze information given; research to gain additional knowledge and work the review in the proper systems as necessary. Responds to or clarifies internal requests for medical information. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, in often in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures

Required Qualifications

  • CPC Certification

  • Acute outpatient coding experience

  • Therapy or Chiropractic billing or coding experience

  • Excellent research and verbal communication skills

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Work at Home/Remote Requirements

  • Must ensure designated work area is free from distractions during work hours and virtual meetings

  • Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

  • Bachelor's degree; RN or LPN designations

  • Additional coding certification in Physical Therapy or Chiropractic

  • Physical Therapy Assistant or previous therapy office experience

Scheduled Weekly Hours