Remote Medical Coding Auditor – APC & CPT Specialist

Humana; Frankfort (KY); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Professional development

Continuing education

Job summary

Humana is seeking a Medical Coding Auditor for its remote Outpatient Facility/APC Coding Team. You will verify codes, review documentation, and perform CPT/HCPCS reviews to ensure accurate claims processing while maintaining confidentiality.

Ideal candidates have CPT/HCPCS expertise, post-certification experience in outpatient procedures, and strong attention to detail to support process improvements.

Qualifications

• CPC/COC/CCS/ROCC/RHIA/RHIT certification with at least 3 years post-cert experience.
• Post-cert experience in Outpatient Specialty Surgeries and Procedures.
• Strong CPT/HCPCS coding knowledge and ability to read operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Excellent attention to detail and ability to work independently.
• Solid judgment, discretion and ability to handle multiple priorities.

Responsibilities

• Verify and ensure the accuracy, completeness and appropriateness of procedure codes.
• Review medical documentation for clinical indicators and CPT/HCPCS criteria.
• Utilize encoders and coding resources for accurate coding.
• Perform CPT/HCPCS Procedure reviews and audits.
• Conduct peer reviews and provide reports as needed.
• Maintain patient/physician confidentiality per HIPAA and regulations.
• Keep current with ICD-10 and CPT guidelines and updates.
• Enter claim/encounter data into appropriate systems.
• Support quality improvement initiatives and process enhancements.

Skills

CPC/COC/CCS/ROCC/RHIA/RHIT certificate

CPT/HCPCS coding

Operative report review

Attention to detail

Independent judgment

Microsoft Office (Word/Excel)

Tools

3M Coder software

Job description

Humana is seeking a Medical Coding Auditor for its remote Outpatient Facility/APC Coding Team. You will verify codes, review documentation, and perform CPT/HCPCS reviews to ensure accurate claims processing while maintaining confidentiality.

Ideal candidates have CPT/HCPCS expertise, post-certification experience in outpatient procedures, and strong attention to detail to support process improvements.