Remote Medical Coding Auditor: CPT/HCPCS & APC Review

Humana; Jackson (MS); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Professional development

Job summary

Humana is seeking a Medical Coding Auditor to review outpatient CPT/HCPCS coding, analyze medical records, and ensure accuracy in payer systems.

You will use encoders, perform CPT/HCPCS reviews, conduct peer reviews, and maintain confidentiality under HIPAA. Remote position with occasional travel to Humana offices.

Typical hours Monday–Friday, 40 hours/week; requires CPC/COC/CCS/ROCC/RHIA/RHIT certifications and 3+ years post-certification experience.

Qualifications

• Certification in CPC/COC/CCS/ROCC/RHIA/RHIT with post-certification experience.
• Strong CPT/HCPCS coding knowledge and ability to read operative reports.
• Experience with coding for outpatient surgeries and procedures.
• Ability to exercise judgment, work independently and manage multiple priorities.
• Proficiency with Microsoft Office (Word/Excel)

Responsibilities

• Verify accuracy of procedure codes based on services rendered.
• Review documentation to meet APC/outpatient facility coding guidelines.
• Utilize encoders and coding resources.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews and provide reports as needed.
• Maintain patient/physician confidentiality per HIPAA and policy.
• Stay updated on ICD-10 and CPT guidelines and regulatory changes.
• Enter claim/encounter data into systems.
• Support quality improvement initiatives.

Skills

CPC Certification

COC Certification

CCS Certification

ROCC Certification

RHIA Certification

RHIT Certification

CPT/HCPCS knowledge

Operative reports reading

Attention to detail

Independent work

MS Office knowledge

3M Coder software

Encoders usage

Tools

3M Coder software

Encoders

Job description

Humana is seeking a Medical Coding Auditor to review outpatient CPT/HCPCS coding, analyze medical records, and ensure accuracy in payer systems.

You will use encoders, perform CPT/HCPCS reviews, conduct peer reviews, and maintain confidentiality under HIPAA. Remote position with occasional travel to Humana offices.

Typical hours Monday–Friday, 40 hours/week; requires CPC/COC/CCS/ROCC/RHIA/RHIT certifications and 3+ years post-certification experience.