Remote Medical Coding Auditor: APC/CPT Specialist

Humana Inc; Cheyenne (WY); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana Inc. is seeking a Medical Coding Auditor to review outpatient claims and ensure CPT/HCPCS coding accuracy. This remote role supports the Outpatient Facility/APC Coding Team with documentation review, encoder usage, and compliance with coding guidelines.

You will verify procedure codes, analyze medical records, and participate in quality improvement initiatives while maintaining patient confidentiality. Some travel to Humana offices may be required.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience.
• Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures.
• Strong knowledge of CPT/HCPCS coding.
• Experience reading & coding from operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information.
• Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities.
• Comfortable working in a production-based work environment.
• Ability to work independently and manage workload.
• Strong written and verbal communication skills; strong analytical, organizational and time management skills.
• Working knowledge of Microsoft Office Programs (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 experience

Microsoft Office

Tools

3M Coder

Job description

Humana Inc. is seeking a Medical Coding Auditor to review outpatient claims and ensure CPT/HCPCS coding accuracy. This remote role supports the Outpatient Facility/APC Coding Team with documentation review, encoder usage, and compliance with coding guidelines.

You will verify procedure codes, analyze medical records, and participate in quality improvement initiatives while maintaining patient confidentiality. Some travel to Humana offices may be required.