Remote Medical Coding Auditor: CPT/ICD-10 Expert

DaMar Staffing; Frankfort (KY); On-site; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor for its Outpatient Facility/APC Coding Team. The role involves verifying procedure codes, reviewing documentation for clinical indicators, and ensuring coding guidelines compliance to support accurate payments.

Remote position with occasional travel to Humana offices for training. Requires CPC/COC/CCS/ROCC/RHIA/RHIT certifications and 3+ years post-certification experience, plus strong CPT/HCPCS knowledge.

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 & 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
• Comfortable working in a production-based work environment
• Ability to work independently and manage workload
• Strong written and verbal communication 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

CPC Certification

COC Certification

CCS Certification

RHIA/RHIT Certification

CPT/HCPCS coding

Attention to detail

Independent worker

Microsoft Office

Education

Medical Coding Certifications (CPC/COC/CCS/ROCC/RHIA/RHIT)

Tools

Microsoft Office

Job description

Humana is seeking a Medical Coding Auditor for its Outpatient Facility/APC Coding Team. The role involves verifying procedure codes, reviewing documentation for clinical indicators, and ensuring coding guidelines compliance to support accurate payments.

Remote position with occasional travel to Humana offices for training. Requires CPC/COC/CCS/ROCC/RHIA/RHIT certifications and 3+ years post-certification experience, plus strong CPT/HCPCS knowledge.