Remote Medical Coding Auditor — Outpatient APC Specialist

Humana; Des Moines (IA); Remote; USD 59,000 - 81,000; Full time

Job summary

Humana seeks a Medical Coding Auditor to review outpatient claims against records, ensuring accurate CPT/HCPCS codes and APC alignment. You will analyze documentation, use encoders, and perform reviews to support accurate provider payments.

You will work remotely, with possible travel to Humana offices for training. Strong CPT/HCPCS knowledge and post-certification experience are required, along with attention to detail and independence.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT certification with at least 3 years post-certification experience.

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 criteria and coding guidelines for APC/outpatient facility.
• Utilize encoders and coding resources to support coding.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews to ensure compliance and provide reports.
• Maintain patient/physician confidentiality under PHI/HIPAA.
• Keep current knowledge of ICD-10 and CPT guidelines and government regulations.
• Enter claim/encounter information in systems.
• Support process and quality improvement initiatives.

Skills

CPC Certification

COC Certification

CCS Certification

RHIA Certification

RHIT Certification

Post-certification experience

Outpatient surgeries experience

CPT/HCPCS knowledge

Operative report coding

Therapeutic Infusion experience

Attention to detail

Independent work

MS Office proficiency

3M Coder software

Education

Medical Coding Certification (CPC/COC/CCS/RHIA/RHIT)

Tools

3M Coder software

Job description

Humana seeks a Medical Coding Auditor to review outpatient claims against records, ensuring accurate CPT/HCPCS codes and APC alignment. You will analyze documentation, use encoders, and perform reviews to support accurate provider payments.

You will work remotely, with possible travel to Humana offices for training. Strong CPT/HCPCS knowledge and post-certification experience are required, along with attention to detail and independence.