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Humana Inc.

APC Medical Coding Auditor

Humana Inc. - Troy, MI

APC Medical Coding Auditor




Job #672817074

Role: APC Medical Coding Auditor

Assignment: Provider Payment Integrity/Clinical Audit

Location: Virtual

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Be a part of the Provider Payment Integrity world-- Evaluate the business and system processes through the eyes of customers, members and provider partners leads to measurable improvements in cost, quality and speed to market.

Humana is seeking an Outpatient Coding Auditor specific to Ambulatory Payment Classification(APC) identify, collect, assess, monitor and document claims and encounter coding information. Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis and procedure codes based on services rendered. In this role you will:

Review medical record information to identify all appropriate coding specific to Ambulatory Payment Classification (APC)

Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.

Support and participate in process and quality improvement initiatives.

Role Essentials

Certified Medical Coder with at least one of the following credentials: CPC, CCS, RHIA, RHIT

High school diploma

3 years prior coding experience

Outpatient auditing experience

Experience reading & coding from operative reports

Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information

Ability to work independently and manage work load

Comfortable working in a production based work environment

Knowledge and experience in the health care environment/managed care

Strong written and verbal communication skills; strong analytical, organizational and time management skills

Strong knowledge of Microsoft Office products (Word, Excel)

Strong knowledge of CPT/HCPS coding

Role Desirables

5 years prior coding experience

Ambulatory Payment Classification (APC)

Proven proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology and medicine

Chemotherapy Infusion experience / Radiation Oncology coding experience

Strong knowledge of Microsoft Access

Experience in prospective payment methodologies

Strong knowledge of ICD-10 coding

3M Coder/EncoderPro experience


APC Medical Coding Auditor



Other Locations:

US-Oklahoma-Tulsa, US-IN-Indianapolis, US-Maryland-Bethesda, US-New Jersey-Jersey City, US-New York-Albany, US-FL-Tampa, US-New Hampshire-Portsmouth, US-TN-Brentwood, US-Minnesota-Minneapolis, US-Connecticut-Bridgeport, US-Mississippi-Ridgeland, US-Illinois-Chicago, US-GA-Atlanta, US-North Carolina-Charlotte, US-OH-Cincinnati, US-Louisiana-Metairie, US-Michigan-Troy, US-Virginia-Glen Allen, US-South Carolina-Lancaster

Requisition ID:


Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.

Updated 05/29/2018

20 days

Humana Inc.


APC Medical Coding Auditor Humana Inc. - Troy, MI, United States


Location: Troy, MI

Company Profile:
Humana's diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Find out how Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.