Remote Medical Coding Auditor – CPT/HCPCS Expert

Humana; Little Rock (AR); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote opportunity

Bonus incentive plan

Job summary

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring accurate CPT/HCPCS and APC coding. The role emphasizes independent judgment, adherence to guidelines, and contributing to cost reduction by improving provider payment accuracy.

Remote work with occasional travel may be required. Responsibilities include code verification, documentation review, CPT/HCPCS reviews, peer auditing, and maintaining HIPAA confidentiality.

Qualifications

• Certification in medical coding (CPC/COC/CCS, RHIA or RHIT) with post-certification experience.
• Minimum 3 years post-certification experience in Outpatient Specialty Surgeries and Procedures.
• Strong CPT/HCPCS knowledge and ability to code from operative reports.

Responsibilities

• Verify accuracy of procedure codes based on services rendered.
• Review documentation to ensure clinical criteria for APC/outpatient coding.
• Perform CPT/HCPCS reviews and audits.
• Conduct peer reviews and provide reports as needed.
• Maintain confidentiality and comply with HIPAA.
• Keep up-to-date with ICD-10 and CPT coding guidelines.
• Enter claim/encounter data in systems.
• Support process and quality improvements.

Skills

CPC/COC/CCS/RHIA/RHIT Certification

CPT/HCPCS coding

Operative report coding

Chemotherapy/Infusion coding

Attention to detail

Independent problem solving

Microsoft Word/Excel

Education

CPC/COC/CCS/RHIA/RHIT Certification

Tools

3M Coder software

Encoders and coding resources

Job description

Humana is seeking a Medical Coding Auditor to review medical claims against records, ensuring accurate CPT/HCPCS and APC coding. The role emphasizes independent judgment, adherence to guidelines, and contributing to cost reduction by improving provider payment accuracy.

Remote work with occasional travel may be required. Responsibilities include code verification, documentation review, CPT/HCPCS reviews, peer auditing, and maintaining HIPAA confidentiality.