Medical Coding Auditor

Humana is seeking a detail-oriented Medical Coding Auditor to join its team in Providence, Providence County — a full-time opportunity for a coding professional ready to apply independent expertise in a dynamic, compliance-driven environment.

About the Role

As a Medical Coding Auditor at Humana, you will evaluate submitted medical claims alongside corresponding medical records to verify that coding practices align with established guidelines, including ICD-10-CM, CPT, and HCPCS standards. This position carries a broad scope of responsibility — assignments vary in complexity and routinely call for professional judgment and self-directed decision-making rather than step-by-step instruction.

Key Responsibilities

• Audit medical claims by cross-referencing them with clinical documentation to confirm coding accuracy and compliance
• Apply ICD-10-CM, CPT, and HCPCS coding systems to assess whether submitted codes reflect documented diagnoses and procedures
• Independently interpret ambiguous or complex cases and determine appropriate corrective action
• Handle a varied workload spanning multiple claim types, specialties, or payer categories
• Identify patterns of coding discrepancies and contribute findings that support quality improvement efforts

Qualifications

• Solid working knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines
• Demonstrated ability to audit medical records and evaluate claim accuracy independently
• Strong analytical and critical-thinking skills suited to varied, non-routine assignments
• Professional coding certification (such as CPC, CCS, or equivalent) is typically expected for roles at this level

About Humana

Humana is a leading health and well-being company committed to helping members achieve their best health. With a nationwide presence, Humana offers careers that blend meaningful work with professional growth across clinical, administrative, and operational disciplines.

How to Apply

To apply for this Medical Coding Auditor position at Humana in Providence, visit the full job listing on Adzuna for complete details and application instructions.