Remote Medical Coding Auditor – APC/Outpatient

Humana Inc; Augusta (ME); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Medical, dental & vision benefits

401(k) retirement plan

Paid time off

Disability insurance

Life insurance

Professional development

Job summary

Humana Inc. seeks a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will verify procedure codes, review clinical indicators, and ensure compliance with APC/outpatient guidelines while maintaining confidentiality.

Role requires CPT/HCPCS mastery, post-certification experience, and careful, independent judgment. Remote work with occasional travel, standard hours, and ongoing professional development are provided.

Qualifications

• CPC/COC/CCS/ROCC/RHIA/RHIT certification with 3+ years post-certification experience.
• 3+ years of post-certification experience in Outpatient Specialty surgeries and procedures.
• Strong CPT/HCPCS coding knowledge and ability to read operative reports.
• Chemotherapy/infusion coding experience preferred.
• Ability to exercise sound judgment and manage multiple priorities independently.
• Proficient with Microsoft Office (Word/Excel).

Responsibilities

• Verify and ensure accuracy of procedure codes based on services rendered.
• Review medical documentation to meet APC and outpatient coding guidelines.
• Use encoders and coding resources to support accurate coding.
• Perform CPT/HCPCS procedure reviews and audits.
• Conduct peer reviews and provide clear reporting of findings.
• Maintain patient and physician confidentiality per HIPAA and guidelines.
• Stay current with ICD-10 and CPT coding guidelines and regulations.
• Enter claim/encounter information accurately in systems and support QA improvements.

Skills

CPC/COC/CCS/ROCC/RHIA/RHIT

CPT/HCPCS knowledge

Operative reports reading

Chemotherapy/Infusion experience

Independent judgment & discretion

Microsoft Word/Excel proficiency

Tools

3M Coder software

Job description

Humana Inc. seeks a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will verify procedure codes, review clinical indicators, and ensure compliance with APC/outpatient guidelines while maintaining confidentiality.

Role requires CPT/HCPCS mastery, post-certification experience, and careful, independent judgment. Remote work with occasional travel, standard hours, and ongoing professional development are provided.