Remote Medical Coding Auditor — APC/CPT Expert

Humana; Montgomery (AL); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring correct coding (ICD-10-CM, CPT, HCPCS) and accurate APC assignments for outpatient services. The role emphasizes independence, adherence to guidelines, and contributing to cost reduction.

You will verify codes, analyze documentation, use encoders, perform CPT/HCPCS reviews, and participate in process improvements. Remote work with occasional travel for training; 40 hours weekly; requires

Qualifications

• Certified coder with CPT/HCPCS expertise and post-certification experience.
• Experience reading and coding from operative reports.
• Knowledge of CPT/HCPCS and chemotherapy/infusion coding.

Responsibilities

• Verify and ensure accuracy of procedure codes based on services rendered.
• Review medical documentation to ensure clinical criteria and coding guidelines.
• Utilize encoders and coding resources for CPT/HCPCS reviews.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews and generate necessary reports.
• Maintain patient/physician confidentiality per HIPAA and guidelines.
• Keep current with ICD-10 and CPT coding rules and government regulations.
• Enter claim/encounter information into systems.
• Support process and quality improvement initiatives.

Skills

CPC/COC/CCS/RHIA/RHIT

CPT/HCPCS coding

Operative reports

Chemotherapy infusion

Microsoft Office

Education

CPC/COC/CCS/RHIA/RHIT Certification

Tools

3M Coder

Job description

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring correct coding (ICD-10-CM, CPT, HCPCS) and accurate APC assignments for outpatient services. The role emphasizes independence, adherence to guidelines, and contributing to cost reduction.

You will verify codes, analyze documentation, use encoders, perform CPT/HCPCS reviews, and participate in process improvements. Remote work with occasional travel for training; 40 hours weekly; requires