Remote Medical Coding Auditor – CPT/HCPCS Expert

DaMar Staffing; Jackson (MS); On-site; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor to review outpatient facility claims against medical records, ensuring accurate CPT/HCPCS coding and APC alignment. This remote role supports the Outpatient Facility/APC Coding Team with coding reviews and documentation.

You will use encoders and coding references, perform peer reviews, maintain HIPAA confidentiality, and stay current with ICD-10 and CPT guidelines. Typical schedule is Monday–Friday with travel for training as needed.

Qualifications

• Certified coder with 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 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

CPC/CAC/COC/CCS/RHIA/RHIT

CPT/HCPCS coding

Operative report coding

Chemotherapy/Therapeutic Infusion

Attention to detail

Independent decision making

Communication skills

MS Office (Word/Excel)

Tools

3M Coder software

Job description

Humana is seeking a Medical Coding Auditor to review outpatient facility claims against medical records, ensuring accurate CPT/HCPCS coding and APC alignment. This remote role supports the Outpatient Facility/APC Coding Team with coding reviews and documentation.

You will use encoders and coding references, perform peer reviews, maintain HIPAA confidentiality, and stay current with ICD-10 and CPT guidelines. Typical schedule is Monday–Friday with travel for training as needed.