Remote Medical Coding Auditor: APC/CPT Specialist

Humana; Annapolis (MD); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana is seeking a Medical Coding Auditor to remotely review outpatient claims and ensure accurate CPT/HCPCS coding against medical records. You will verify codes, analyze documentation, and support quality initiatives while maintaining patient confidentiality.

Travel to Humana offices may be required for training. The role emphasizes independent work, strong CPT/HCPCS knowledge, and experience with radiation/infusion coding as part of outpatient services.

Qualifications

• CPC, COC, CCS, ROCC, RHIA or RHIT Certification with at least 3 years post-certification experience
• Minimum of 3 years post-certification experience in Outpatient Specialty Surgeries and Procedures
• Strong knowledge of CPT/HCPCS coding
• Experience reading and coding from operative reports
• Chemotherapy or Therapeutic Infusion experience
• Ability to work independently with multiple priorities
• Strong written and verbal communication, analytical and time-management skills
• Proficiency in Microsoft Office (Word, Excel)

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 specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Outpatient Facility coding
• Utilize encoders and various coding resources
• Perform CPT/HCPCS Procedure reviews
• Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
• Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
• Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
• Complete appropriate system(s) entry regarding claim/encounter information
• Support and participate in process and quality improvement initiatives

Skills

CPC, COC, CCS, ROCC, RHIA, RHIT

CPT/HCPCS coding

Operative reports

Chemotherapy infusion

Attention to detail

Microsoft Office

Education

CPC/COC/CCS/RHIA/RHIT Certification

Tools

3M Coder software

Job description

Humana is seeking a Medical Coding Auditor to remotely review outpatient claims and ensure accurate CPT/HCPCS coding against medical records. You will verify codes, analyze documentation, and support quality initiatives while maintaining patient confidentiality.

Travel to Humana offices may be required for training. The role emphasizes independent work, strong CPT/HCPCS knowledge, and experience with radiation/infusion coding as part of outpatient services.