Remote Medical Coding Auditor - CPT/HCPCS & APC Specialist

Humana; Carson City (NV); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Professional development

Continued education

Job summary

Humana is seeking a Medical Coding Auditor to join our Outpatient Facility/APC coding team in a remote capacity, with occasional travel for training. You will verify procedure codes, review clinical documentation, perform CPT/HCPCS reviews, and support quality improvements while protecting patient information and HIPAA rules.

Required certifications CPC/COC/CCS/ROCC/RHIA/RHIT with 3+ years post-certification experience and strong CPT/HCPCS knowledge, including experience with

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 & 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
• 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 Ambulatory Payment Classification (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 report coding

Attention to detail

Independent work

Strong communication

Microsoft Office

Education

CPC Certification

COC Certification

CCS Certification

ROCC Certification

RHIA Certification

RHIT Certification

Tools

Microsoft Office (Word, Excel)

Job description

Humana is seeking a Medical Coding Auditor to join our Outpatient Facility/APC coding team in a remote capacity, with occasional travel for training. You will verify procedure codes, review clinical documentation, perform CPT/HCPCS reviews, and support quality improvements while protecting patient information and HIPAA rules.

Required certifications CPC/COC/CCS/ROCC/RHIA/RHIT with 3+ years post-certification experience and strong CPT/HCPCS knowledge, including experience with