Remote Medical Coding Auditor | CPT/HCPCS Specialist

Humana; Concord (NH); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Bonus potential

Travel opportunities

Job summary

Humana is seeking a Medical Coding Auditor to review outpatient claims and ensure CPT/HCPCS coding accuracy against medical records. This remote role emphasizes independent judgment, adherence to guidelines, and collaboration with the APC/Outpatient Coding Team.

Responsibilities include coding validation, documentation review, and participation in quality improvement initiatives. Remote work with periodic trainings or meetings may be required.

Qualifications

• CPC, COC, CCS, ROCC, RHIA or RHIT certification with at least 3 years post-certification experience.
• Minimum of 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, ability to work independently and manage multiple priorities.
• Comfortable working in a production-based environment.
• Ability to work independently and manage workload.

Responsibilities

• Verify and ensure accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered.
• Review medical documentation for clinical indicators to ensure procedures meet criteria and 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.
• Maintain patient and physician confidentiality following HIPAA and all guidelines.
• Maintain current knowledge of ICD-10 and CPT coding guidelines and regulations.
• Enter claim/encounter information into systems.
• Support and participate in process and quality improvement initiatives.

Skills

CPC/COC/CCS/RHIA/RHIT

CPT/HCPCS coding

Operative reports

Chemotherapy infusion

Communication skills

MS Office

Tools

3M Coder software

Job description

Humana is seeking a Medical Coding Auditor to review outpatient claims and ensure CPT/HCPCS coding accuracy against medical records. This remote role emphasizes independent judgment, adherence to guidelines, and collaboration with the APC/Outpatient Coding Team.

Responsibilities include coding validation, documentation review, and participation in quality improvement initiatives. Remote work with periodic trainings or meetings may be required.