Remote Medical Coding Auditor – CPT/HCPCS & APC Specialist

Humana Inc; Boise (ID); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana Inc. is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team to review medical claims, ensure accurate CPT/HCPCS coding, and support quality improvements. The role emphasizes independent judgment, confidentiality, and adherence to coding guidelines.

You will verify codes, review documentation, and perform CPT/HCPCS reviews, with remote work and occasional travel for training. Strong communication and detail-oriented skills are essential.

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 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, & ability to handle 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 reports

Attention to detail

Independent work

Microsoft Office (Word, Excel)

Communication skills

Education

CPC, COC, CCS, ROCC, RHIA, RHIT Certification

Tools

3M Coder software

Encoders

Microsoft Office

Job description

Humana Inc. is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team to review medical claims, ensure accurate CPT/HCPCS coding, and support quality improvements. The role emphasizes independent judgment, confidentiality, and adherence to coding guidelines.

You will verify codes, review documentation, and perform CPT/HCPCS reviews, with remote work and occasional travel for training. Strong communication and detail-oriented skills are essential.