Remote Medical Coding Auditor: CPT/HCPCS & APC

Humana; Madison (WI); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor to review outpatient claims for accurate CPT/HCPCS coding and ICD-10-CM references. The role emphasizes accuracy, confidentiality, and adherence to guidelines in an outpatient setting.

You will analyze documentation, perform CPT/HCPCS reviews, conduct peer reviews, and support process improvements. Remote work from home with occasional travel to Humana offices for training.

Qualifications

• CPC/COC/CCS/ROCC/RHIA/RHIT certification with at least 3 years post-certification experience
• Minimum 3 years post-certification experience in Outpatient Specialty Surgeries and Procedures
• Strong CPT/HCPCS coding knowledge
• Experience reading and coding from operative reports
• Chemotherapy and/or Therapeutic Infusion experience
• Solid judgment, discretion in handling information and ability to manage multiple priorities
• Strong written and verbal communication skills; analytical, organizational and time management abilities
• Proficient with Microsoft Office (Word, Excel)

Responsibilities

• Verify and ensure correct procedure codes based on services rendered.
• Review medical documentation for clinical indicators to meet APC and Outpatient Facility coding guidelines.
• Utilize encoders and coding resources.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed.
• Maintain patient and physician confidentiality per HIPAA and applicable guidelines.
• Keep up-to-date with ICD-10 and CPT coding guidelines and regulations.
• Enter claim/encounter information in systems accurately.
• Support and participate in process and quality improvement initiatives.

Skills

CPC Certification

COC Certification

CCS Certification

ROCC Certification

RHIA Certification

RHIT Certification

CPT Coding

HCPCS Coding

Outpatient Coding

3+ Years Experience

Tools

Microsoft Word

Microsoft Excel

Job description

Humana is seeking a Medical Coding Auditor to review outpatient claims for accurate CPT/HCPCS coding and ICD-10-CM references. The role emphasizes accuracy, confidentiality, and adherence to guidelines in an outpatient setting.

You will analyze documentation, perform CPT/HCPCS reviews, conduct peer reviews, and support process improvements. Remote work from home with occasional travel to Humana offices for training.