Remote Medical Coding Auditor CPT/HCPCS Expert

Humana Inc; Richmond (VA); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote opportunity

Professional development

Continued education

Job summary

Humana Inc. is seeking a Medical Coding Auditor to review outpatient facility claims, ensuring accurate CPT/HCPCS coding and alignment with medical records. You will analyze documentation, apply coding guidelines, and contribute to cost reduction while safeguarding patient privacy.

In this remote role, you will verify codes, review operative reports, and support process improvements. Travel to Humana offices for training may be required; typical hours are 40 per week with strong emphasis on

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 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.
• Strong attention to detail; able to work independently with multiple priorities.

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.
• 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 and follow HIPAA guidelines.
• Maintain current knowledge of ICD-10 and CPT coding guidelines and related regulations.
• Complete appropriate system entries regarding claim/encounter information.
• Support and participate in process and quality improvement initiatives.

Skills

CPT/HCPCS knowledge

Attention to detail

Independent worker

Communication skills

Education

CPC, COC, CCS, ROCC, RHIA, or RHIT Certification

Tools

Microsoft Office

Job description

Humana Inc. is seeking a Medical Coding Auditor to review outpatient facility claims, ensuring accurate CPT/HCPCS coding and alignment with medical records. You will analyze documentation, apply coding guidelines, and contribute to cost reduction while safeguarding patient privacy.

In this remote role, you will verify codes, review operative reports, and support process improvements. Travel to Humana offices for training may be required; typical hours are 40 per week with strong emphasis on