Remote Medical Coding Auditor CPT/HCPCS Specialist

Humana Inc; Honolulu (HI); On-site; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Bonus incentive plan

Occasional travel for training

Job summary

Humana Inc is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will review medical claims against records to ensure correct ICD-10-CM, CPT and HCPCS coding and support cost reduction through accurate payments.

Key duties include verifying procedure codes, evaluating documentation against clinical criteria, using coding resources and performing CPT/HCPCS reviews. You will maintain confidentiality and stay current with ICD-10 and CPT guidelines.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT certification with at least 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 & coding from operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information.
• Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities.
• Comfortable working in a production-based work environment.
• Ability to work independently and manage workload.
• Strong written and verbal communication skills; strong analytical, organizational and time management skills.
• Working knowledge of Microsoft Office Programs (Word, Excel)

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 specific to 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 strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
• Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
• Complete appropriate system(s) entry regarding claim/encounter information
• Support and participate in process and quality improvement initiatives

Skills

CPT/HCPCS coding

Operative report reading

Attention to detail

Independent work

Strong communication

Chemotherapy infusion knowledge

Education

CPC/COC/CCS/RHIA/RHIT Certification

Tools

3M Coder software

Encoders

MS Office

Job description

Humana Inc is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will review medical claims against records to ensure correct ICD-10-CM, CPT and HCPCS coding and support cost reduction through accurate payments.

Key duties include verifying procedure codes, evaluating documentation against clinical criteria, using coding resources and performing CPT/HCPCS reviews. You will maintain confidentiality and stay current with ICD-10 and CPT guidelines.