Remote Medical Coding Auditor – APC & CPT Expert

Humana CenterWell Home Health Orangeburg; United States; Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana CenterWell Home Health Orangeburg is seeking a Medical Coding Auditor to review outpatient claims, verify CPT/HCPCS coding, and ensure ICD-10-CM guideline compliance. The role emphasizes accuracy, independent judgment, and collaboration with clinical teams.

Responsibilities include CPT/HCPCS reviews, encoder usage, and participation in quality improvement while maintaining HIPAA confidentiality. Remote work with occasional training travel may be required.

Qualifications

• CPC/COC/CCS/ROCC/RHIA/RHIT certification with minimum 3 years post-certification experience.
• Minimum 3 years post-certification experience in Outpatient Specialty Surgeries and Procedures.
• Strong knowledge of CPT/HCPCS coding and experience reading operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Proven ability to exercise judgment and manage multiple priorities independently.
• Strong written and verbal communication skills; attention to detail.

Responsibilities

• Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered.
• Review medical documentation for clinical indicators to ensure procedures meet criteria and coding guidelines for APC/outpatient facility
• Utilize encoders and various coding resources
• Perform CPT/HCPCS Procedure reviews
• Conduct peer reviews to ensure compliance and provide reports
• Maintain patient/physician confidentiality and HIPAA compliance
• Maintain current knowledge of ICD-10 and CPT guidelines and regulations
• Complete system entries for claim/encounter information
• Support quality improvement initiatives

Skills

CPT/HCPCS coding

Attention to detail

Independent judgment

Communication skills

Microsoft Office

Education

CPC/COC/CCS/ROCC/RHIA/RHIT Certification

Tools

3M Coder software

Job description

Humana CenterWell Home Health Orangeburg is seeking a Medical Coding Auditor to review outpatient claims, verify CPT/HCPCS coding, and ensure ICD-10-CM guideline compliance. The role emphasizes accuracy, independent judgment, and collaboration with clinical teams.

Responsibilities include CPT/HCPCS reviews, encoder usage, and participation in quality improvement while maintaining HIPAA confidentiality. Remote work with occasional training travel may be required.