Remote Medical Coding Auditor – Outpatient APC

DaMar Staffing; Annapolis (MD); On-site; USD 59,000 - 81,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Paid parental and caregiver leave

Job summary

Humana offers a remote coding auditor position focused on reviewing medical claims for accuracy in CPT/HCPCS coding within outpatient facility settings. You will verify codes against clinical documentation and use encoders to ensure appropriate APC assignments.

The role requires certified coders with substantial outpatient coding experience, strong attention to detail, and the ability to work independently in a production environment. Travel to offices is possible for training.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT Certification required.
• Minimum of 3 years post‑certification experience in Outpatient Specialty Surgeries and Procedures.
• Strong knowledge of CPT/HCPCS coding.
• Experience reading and coding from operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Solid judgment and discretion in handling information.
• Detail oriented and able to manage multiple priorities.
• Experience with Microsoft Office programs.

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 procedures meet clinical criteria and correct coding guidelines related 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 federal, state and hospital release guidelines.
• Maintain current knowledge of ICD-10 and CPT coding guidelines, government regulations and protocols.
• Complete system entries regarding claim/encounter information.
• Support and participate in process and quality improvement initiatives.

Skills

CPC

COC

CCS

ROCC

RHIA

RHIT

CPT/HCPCS knowledge

Outpatient coding

Attention to detail

Independence

Microsoft Office

Tools

3M Coder software

Job description

Humana offers a remote coding auditor position focused on reviewing medical claims for accuracy in CPT/HCPCS coding within outpatient facility settings. You will verify codes against clinical documentation and use encoders to ensure appropriate APC assignments.

The role requires certified coders with substantial outpatient coding experience, strong attention to detail, and the ability to work independently in a production environment. Travel to offices is possible for training.