Remote Medical Coding Auditor (CPT/HCPCS, APC)

Humana; United States; Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Bonus opportunity

Job summary

Humana seeks a Medical Coding Auditor to review medical claims against records, ensuring accurate CPT/HCPCS/ICD-10-CM coding. You will interpret guidelines, contribute to cost reduction, and support APC outpatient coding teams.

Remote with occasional travel for training/meetings. Requires 3+ years post-certification, CPT/HCPCS mastery, and strong attention to detail in a production setting. 40 hours weekly, with a bonus plan eligibility.

Qualifications

• CPC/COC/CCS/ROCC/RHIA or RHIT certification with a minimum of 3 years post-certification experience.
• Minimum of 3 years post-certification experience in Outpatient Specialty Surgeries and Procedures.
• Strong knowledge of CPT/HCPCS coding.
• Experience reading and 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, ability to work independently and manage multiple priorities.
• Comfortable in a production-based work environment.
• 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 and appropriateness of procedure codes based on services rendered.
• Review medical documentation for clinical indicators to ensure CPT/HCPCS coding meets criteria for 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.
• Maintain patient and physician confidentiality per HIPAA and related guidelines.
• Maintain current knowledge of ICD-10 and CPT coding guidelines and regulations.
• Enter and update claim/encounter information in systems.
• Support and participate in process and quality improvement initiatives.

Skills

CPT/HCPCS knowledge

Operative reports coding

Attention to detail

Communication skills

MS Office (Word/Excel)

Education

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

3+ years post-certification experience

Tools

3M Coder software

Coding encoders/resources

Job description

Humana seeks a Medical Coding Auditor to review medical claims against records, ensuring accurate CPT/HCPCS/ICD-10-CM coding. You will interpret guidelines, contribute to cost reduction, and support APC outpatient coding teams.

Remote with occasional travel for training/meetings. Requires 3+ years post-certification, CPT/HCPCS mastery, and strong attention to detail in a production setting. 40 hours weekly, with a bonus plan eligibility.