Remote Medical Coding Auditor — CPT/HCPCS Specialist

Humana; Trenton (NJ); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor to review outpatient claims against medical records, ensuring CPT/HCPCS/ICD-10-CM coding accuracy. The remote role supports APC coding and performs reviews, encoders use, and documentation checks.

Some travel to Humana offices for training may be required. Qualifications include CPC/COC/CCS with 3+ years post-certification, CPT/HCPCS proficiency, and experience reading operative reports; chemotherapy/infusion experience is a plus.

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”

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/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 guidelines for release of information
• Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
• Complete appropriate system entries regarding claim/encounter information
• Support and participate in process and quality improvement initiatives

Skills

CPC

COC

CCS

ROCC

RHIA

RHIT

CPT/HCPCS coding

Operative reports

Chemotherapy/Infusion

Attention to detail

Independent work

Microsoft Office (Word/Excel)

Tools

Encoders

3M Coder software

Job description

Humana is seeking a Medical Coding Auditor to review outpatient claims against medical records, ensuring CPT/HCPCS/ICD-10-CM coding accuracy. The remote role supports APC coding and performs reviews, encoders use, and documentation checks.

Some travel to Humana offices for training may be required. Qualifications include CPC/COC/CCS with 3+ years post-certification, CPT/HCPCS proficiency, and experience reading operative reports; chemotherapy/infusion experience is a plus.