Remote Medical Coding Auditor — CPT/HCPCS Expert

Humana; Columbia (SC); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor to review outpatient claims against medical records, ensuring CPT/HCPCS alignment and accurate provider payments. The role emphasizes independent judgment, confidentiality, and adherence to coding guidelines within a remote work setup.

You will verify codes, perform reviews, and participate in process improvements while maintaining HIPAA compliance. Travel to Humana offices may be required for training or meetings.

Qualifications

• CPC/COC/CCS/RHIA/RHIT certification with 3+ years post-cert
• Minimum of 3 years post-cert 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

CPC/COC/CCS/RHIA/RHIT

Outpatient coding

CPT/HCPCS coding

Operative reports

Chemotherapy infusion

Attention to detail

Independent work

Communication skills

Tools

Microsoft Word

Microsoft Excel

Job description

Humana is seeking a Medical Coding Auditor to review outpatient claims against medical records, ensuring CPT/HCPCS alignment and accurate provider payments. The role emphasizes independent judgment, confidentiality, and adherence to coding guidelines within a remote work setup.

You will verify codes, perform reviews, and participate in process improvements while maintaining HIPAA compliance. Travel to Humana offices may be required for training or meetings.