Remote Medical Coding Auditor & APC Specialist

Humana Inc; City of Albany (NY); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana Inc. is seeking a Medical Coding Auditor to review outpatient claims and ensure accurate CPT/HCPCS coding against medical records. This remote role involves evaluating documentation, applying coding guidelines, and supporting APC coding conformity to reduce payer risk.

You will verify procedure codes, perform audits, and participate in process improvements while maintaining patient confidentiality and communicating findings clearly. Travel to Humana offices may be required occasionally.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT certification with at least 3 years post-certification experience.
• Minimum 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, and manage 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 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

CPT/HCPCS coding

Operative report coding

Judgment & discretion

Independent work

MS Office (Word, Excel)

Education

CPC/COC/CCS/ROCC/RHIA or RHIT certification

Tools

Microsoft Office

Job description

Humana Inc. is seeking a Medical Coding Auditor to review outpatient claims and ensure accurate CPT/HCPCS coding against medical records. This remote role involves evaluating documentation, applying coding guidelines, and supporting APC coding conformity to reduce payer risk.

You will verify procedure codes, perform audits, and participate in process improvements while maintaining patient confidentiality and communicating findings clearly. Travel to Humana offices may be required occasionally.