Remote Medical Coding Auditor - CPT/ICD Expert

Humana Inc; Montpelier (VT); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana Inc. is hiring a Medical Coding Auditor for a remote role supporting the Outpatient Facility/APC Coding Team.

You will verify code accuracy, review documentation, and ensure compliance with CPT/HCPCS guidelines while maintaining strict PHI privacy and working within established procedures. The role emphasizes independent work, attention to detail, and effective communication as you handle coding reviews, use encoders, and participate in process improvements.

Qualifications

• Certification CPC/COC/CCS/RHIA/RHIT with at least 3 years post-certification experience.
• 3 years post-certification experience in Outpatient Specialty Surgeries.
• Strong CPT/HCPCS coding knowledge.
• Experience reading and coding from operative reports.
• Chemotherapy or Therapeutic Infusion experience.
• Ability to exercise sound judgment and discretion.
• Strong attention to detail and ability to handle multiple priorities.
• Comfortable in a production-based work environment.
• Ability to work independently and manage workload.
• Strong written/verbal communication; analytical and time management skills.
• MS Office (Word, Excel) knowledge.

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 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 entry regarding claim/encounter information.
• Support and participate in process and quality improvement initiatives.

Skills

Coding certs

Outpatient Surgeries

CPT/HCPCS coding

Operative reports

Chemotherapy infusion

Judgment/discretion

Attention to detail

Production environment

Independent work

Analytical skills

MS Office

Tools

3M Coder

Job description

Humana Inc. is hiring a Medical Coding Auditor for a remote role supporting the Outpatient Facility/APC Coding Team.

You will verify code accuracy, review documentation, and ensure compliance with CPT/HCPCS guidelines while maintaining strict PHI privacy and working within established procedures. The role emphasizes independent work, attention to detail, and effective communication as you handle coding reviews, use encoders, and participate in process improvements.