Remote Medical Coding Auditor - CPT/ICD Expert

DaMar Staffing; Harrisburg (Dauphin County); On-site; USD 59,000 - 81,000; Full time

Job summary

Humana is seeking a Medical Coding Auditor to review outpatient/ambulatory coding, ensuring accuracy of CPT/HCPCS and ICD-10-CM codes in reimbursement processes. You will analyze medical records, apply guidelines, and perform audits in a remote setting with periodic travel for training.

The role requires CPC/COC/CCS/ROCC/RHIA/RHIT certification and 3+ years post-certification experience, especially in outpatient surgeries and CPT/HCPCS coding.

Qualifications

• Certification in medical coding (CPC/COC/CCS/ROCC/RHIA/RHIT) required.
• Strong CPT/HCPCS coding knowledge and experience with operative reports.

Responsibilities

• Verify and ensure accuracy and appropriateness of procedure codes based on services rendered.
• Review documentation to ensure clinical criteria meet coding guidelines for APC and outpatient facility coding.
• Utilize encoders and coding resources to support reviews.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews and provide reports as needed.
• Maintain patient and physician confidentiality per HIPAA and policy.
• Keep current with ICD-10 and CPT guidelines and government regulations.
• Complete system entries for claim/encounter information.
• Support process and quality improvement initiatives.

Skills

CPT/HCPCS coding

Operative reports

Chemotherapy infusion

MS Office

Education

CPC, COC, CCS, ROCC, RHIA, or RHIT Certification

Tools

3M Coder

Microsoft Office

Job description

Humana is seeking a Medical Coding Auditor to review outpatient/ambulatory coding, ensuring accuracy of CPT/HCPCS and ICD-10-CM codes in reimbursement processes. You will analyze medical records, apply guidelines, and perform audits in a remote setting with periodic travel for training.

The role requires CPC/COC/CCS/ROCC/RHIA/RHIT certification and 3+ years post-certification experience, especially in outpatient surgeries and CPT/HCPCS coding.