Remote Medical Coding Auditor — CPT/HCPCS Expert

Humana; Juneau (AK); À distance; USD 59 000 - 81 000; Plein temps

Résumé du poste

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring accurate CPT/HCPCS coding for outpatient services. The role emphasizes independent judgment, confidentiality, and adherence to coding guidelines.

Remote position with occasional travel to Humana offices for training; typical hours are Mon-Fri with some flexibility. Requires 3+ years post-certifications and outpatient coding experience.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT certification with at least 3 years post-certification experience
• 3+ years post-certification experience in Outpatient Specialty Surgeries and Procedures
• Strong knowledge of CPT/HCPCS coding
• Experience reading and coding from operative reports
• Chemotherapy and/or Therapeutic Infusion experience
• Demonstrated ability to exercise sound judgment and discretion in handling information
• Strong attention to detail, able to work independently and manage multiple priorities
• Comfortable working in a production-based environment
• Ability to work independently and manage workload
• Strong written and verbal communication skills; proficient in MS Office

Responsabilités

• Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
• Review medical documentation for clinical indicators to ensure criteria meet clinical coding guidelines for 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 patient and physician confidentiality per HIPAA and related guidelines
• Maintain current knowledge of ICD-10 and CPT coding guidelines and government regulations
• Complete system entries for claim/encounter information
• Support and participate in process and quality improvement initiatives

Connaissances

CPT/HCPCS coding

Operative report coding

Chemo/infusion experience

Attention to detail

Independent work

Communication skills

Formation

CPC/COC/CCS/ROCC/RHIA/RHIT certification

Outils

Microsoft Word

Microsoft Excel

Description du poste

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring accurate CPT/HCPCS coding for outpatient services. The role emphasizes independent judgment, confidentiality, and adherence to coding guidelines.

Remote position with occasional travel to Humana offices for training; typical hours are Mon-Fri with some flexibility. Requires 3+ years post-certifications and outpatient coding experience.