Remote Medical Coding Auditor (CPT/HCPCS, APC)

Humana Inc; Salt Lake City (UT); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana Inc. seeks a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will verify code accuracy against medical records, review documentation, and perform CPT/HCPCS reviews to support correct claims payments.

The role requires CPC/COC/CCS/RHIA/RHIT certification with at least 3 years post-certification, strong CPT/HCPCS knowledge, and experience with operative reports. Remote work with occasional travel for training.

Qualifications

• CPC/COC/CCS/ROCC/RHIA/RHIT certification with 3+ years post-certification experience.
• 3+ years post-certificationOutpatient Specialty Surgeries and Procedures experience.
• Strong CPT/HCPCS coding knowledge.
• Experience reading & coding from operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Solid judgment and discretion in handling information.
• Attention to detail; ability to work independently and manage priorities.
• MS Office familiarity.

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 procedures meet clinical criteria for APC/outpatient facility coding.
• Utilize encoders and various coding resources.
• Perform CPT/HCPCS Procedure reviews.
• Conduct peer reviews to ensure coding guideline compliance and produce reports.
• Maintain patient and physician confidentiality following HIPAA guidelines.
• Maintain knowledge of ICD-10 and CPT coding guidelines and government regulations.
• Enter claim/encounter information into systems.
• Support quality improvement initiatives.

Skills

CPC certification

COC certification

CCS certification

ROCC certification

RHIA certification

RHIT certification

Outpatient coding

CPT/HCPCS coding

Operative reports

Attention to detail

Independent work

MS Office

Education

Medical Coding Certification (CPC/COC/CCS/RHIA/RHIT)

Tools

3M Coder

Job description

Humana Inc. seeks a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will verify code accuracy against medical records, review documentation, and perform CPT/HCPCS reviews to support correct claims payments.

The role requires CPC/COC/CCS/RHIA/RHIT certification with at least 3 years post-certification, strong CPT/HCPCS knowledge, and experience with operative reports. Remote work with occasional travel for training.