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Quality Assurance Professional


Become a part of our caring community and help us put health first

This role will complete quality reviews on the coding processes within the Claims Cost Management organization, focusing on the review types of APC, E&M, SCR, and the Outpatient Coding Team.

The Quality Assurance Professional 2 audits the APC associates within Humana internal departments and our partnering vendors. Develops policies, procedures, and methods to check operational quality and improve the same. Trains and/or coaches' staff and management in areas such as quality improvement, process management, and reliability science. Maintains communications with administration, medical staff, and department heads regarding quality assurance activities. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, requires minimal direction, and receives guidance where needed. Follows established guidelines/procedures.

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So, do you love working on several different projects? Do you take pride in helping others and being flexible? Do you have great attention to detail and a passion for healthcare? Do you have a solid background in medical auditing, coding, and medical record review? If you answered YES to one or more of the above, you should strongly consider this role.

Use your skills to make an impact

This role will complete quality reviews on the coding processes within the Claims Cost Management organization, focusing on the review types of APC and the Outpatient Coding Team. This is a full-time remote/work-at-home opportunity.

Required Qualifications

  • 7 years of Ambulatory Payment Classification (APC), Profee and Surgery Auditing.
  • Medical coding certification from AAPC OR AHIMA (CPC, CCS, CIC, CPMA or equivalent).
  • 5+ years of Clinical Radiation Oncology.
  • Strong critical thinking skills.
  • Prior experience reading and coding from medical records.
  • Demonstrated ability to work independently and manage workload.
  • Exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence, and commitment to the profession.
  • Excellent writing, editing, interpersonal, planning, teamwork, and communication skills.
  • Proficient in MS Office applications including Word, Excel, Outlook, PowerPoint.
  • Prior experience working independently and determining appropriate courses of action.
  • Demonstrated experience in effective communication with internal customers through both written and verbal communication.

Work at Home Requirements

  • Must be able to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
  • A dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Preferred Qualifications

  • Outpatient and Inpatient experience.
  • Process improvement experience.
  • Multi-Specialty Auditing experience.

Scheduled Weekly Hours


Scheduled Weekly Hours


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.

$63,400 - $87,400 per year

This 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.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Job ID: humana-R-338878
Employment Type: Full Time