Remote Medical Coding Auditor (APC/CPT Expert)

Humana; Lansing (MI); A distancia; USD 59.000 - 81.000; Jornada completa

Descripción de la vacante

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring CPT/HCPCS coding accuracy and guideline adherence. The role supports APC/outpatient coding, uses encoders, and performs CPT/HCPCS reviews while protecting patient confidentiality.

You will work remotely with potential occasional travel for training or meetings, typical hours Monday–Friday, and focus on Outpatient Facility/APC coding teams with emphasis on accuracy and compliance.

Formación

• CPC, COC, CCS, ROCC, RHIA, or RHIT certification with at least 3 years post-certification experience.
• Minimum 3 years post-certification experience Outpatient Specialty Surgeries and Procedures.
• Strong knowledge of CPT/HCPCS coding.
• Experience reading and coding from operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Strong attention to detail and ability to work independently.
• Excellent written and verbal communication and analytical skills.
• Working knowledge of Microsoft Office (Word, Excel).

Responsabilidades

• Verify and ensure accuracy of procedure codes based on services rendered.
• Review medical documentation for clinical indicators to meet APC/outpatient criteria.
• Utilize encoders and coding resources to support coding decisions.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews to ensure coding guideline compliance and provide reports.
• Maintain patient confidentiality and comply with HIPAA and hospital policies.
• Stay current with ICD-10 and CPT guidelines and related regulations.
• Enter claim/encounter information into the system and support quality initiatives.

Conocimientos

CPT/HCPCS coding

Operative reports coding

Chemotherapy/Infusion coding

Attention to detail

Independent decision making

Microsoft Office (Word/Excel)

Herramientas

3M Coder software

Descripción del empleo

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring CPT/HCPCS coding accuracy and guideline adherence. The role supports APC/outpatient coding, uses encoders, and performs CPT/HCPCS reviews while protecting patient confidentiality.

You will work remotely with potential occasional travel for training or meetings, typical hours Monday–Friday, and focus on Outpatient Facility/APC coding teams with emphasis on accuracy and compliance.