Remote Medical Coding Auditor — APC/CPT Specialist

Humana; Charleston (WV); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor to review medical claims against medical records, ensuring accurate CPT/HCPCS coding and compliance. You will analyze documentation, verify codes, and participate in process improvement while supporting remote work-life balance.

The role emphasizes independent decision-making, attention to detail, and knowledge of ICD-10 and CPT guidelines. Some travel to Humana offices may be required for training.

Qualifications

• Certification in medical coding (CPC/COC/CCS/RHIA/RHIT) with post-certification experience.
• Experience reading & coding from operative reports.
• Strong knowledge of CPT/HCPCS coding.
• Ability to work independently and manage multiple priorities.

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.
• 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 HIPAA guidelines.
• Maintain current working knowledge of ICD-10 and CPT coding guidelines.

Skills

CPT/HCPCS coding

Operative report review

Attention to detail

Independent judgment

MS Office (Word/Excel)

Strong communication

Remote work readiness

Education

CPC/COC/CCS/RHIA/RHIT certification

Tools

3M Coder software

Microsoft Office

Job description

Humana is seeking a Medical Coding Auditor to review medical claims against medical records, ensuring accurate CPT/HCPCS coding and compliance. You will analyze documentation, verify codes, and participate in process improvement while supporting remote work-life balance.

The role emphasizes independent decision-making, attention to detail, and knowledge of ICD-10 and CPT guidelines. Some travel to Humana offices may be required for training.