Remote Medical Coding Auditor CPT/HCPCS Specialist

Humana; Bismarck (ND); À distance; USD 59 000 - 81 000; Plein temps

Résumé du poste

Humana is seeking a Medical Coding Auditor to review outpatient claims against medical records, ensuring ICD-10-CM, CPT, HCPCS alignment. This remote role supports the Outpatient Facility/APC Coding Team with independent decision making and adherence to guidelines.

You will verify code accuracy, perform CPT/HCPCS reviews, conduct peer audits, and maintain PHI protections. Some travel to Humana offices may be required for training; typical hours are standard business days.

Qualifications

• Professional certification in medical coding (CPC/COC/CCS/RHIA/RHIT) with post-certification experience.
• Minimum 3 years post-certification experience in outpatient surgeries and procedures.
• Strong CPT/HCPCS coding knowledge.
• Experience reading and coding from operative reports.
• Chemotherapy and/or therapeutic infusion coding experience.
• Demonstrated judgment, discretion and ability to work independently.
• Detail-oriented with ability to manage multiple priorities.

Responsabilités

• Verify accuracy and specificity of codes for outpatient services.
• Review documentation to ensure clinical criteria for APC and guidelines.
• Use encoders and coding resources to support coding decisions.
• Perform CPT/HCPCS procedure reviews and audits.
• Conduct peer reviews and generate compliance reports.
• Maintain patient confidentiality and HIPAA compliance.
• Stay current with ICD-10 and CPT guidelines and regulations.
• Enter claim information in the system and support QA initiatives.

Connaissances

CPC/COC/CCS/RHIA/RHIT Certification

Outpatient surgeries

CPT/HCPCS coding

Operative reports

Chemotherapy infusion coding

Attention to detail

Independent work

Communication skills

Microsoft Office

Outils

Microsoft Office

Description du poste

Humana is seeking a Medical Coding Auditor to review outpatient claims against medical records, ensuring ICD-10-CM, CPT, HCPCS alignment. This remote role supports the Outpatient Facility/APC Coding Team with independent decision making and adherence to guidelines.

You will verify code accuracy, perform CPT/HCPCS reviews, conduct peer audits, and maintain PHI protections. Some travel to Humana offices may be required for training; typical hours are standard business days.