Remote Medical Coding Auditor — Outpatient APC Specialist

Humana; Oklahoma City (OK); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Travel opportunities

Professional development & continued教育

Education reimbursement

Job summary

Humana is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. This remote role reviews medical claims against records to ensure CPT/HCPCS codes are accurate and aligned with guidelines.

Candidates should have CPC/COC/CCS/ROCC/RHIA/RHIT certification with 3+ years post-cert experience and knowledge of chemotherapy/infusion coding. You will use encoders, perform CPT/HCPCS reviews, and participate in process improvements while protecting PHI.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT certification required with a minimum of 3 years post-certification experience.
• Strong knowledge of CPT/HCPCS coding.
• Experience reading and coding from operative reports.
• Chemotherapy and/or Therapeutic Infusion experience.
• Demonstrated judgment and discretion in handling information.
• Attention to detail, ability to work independently, and manage multiple priorities.
• Proficient in Microsoft Office (Word, Excel).
• 3M Coder software experience (preferred).

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 APC and Outpatient Facility guidelines.
• Utilize encoders and coding resources; perform CPT/HCPCS procedure reviews.
• Conduct peer reviews and provide reports on coding compliance as needed.
• Maintain patient and physician confidentiality and follow PHI/HIPAA guidelines.
• Keep current with ICD-10 and CPT coding guidelines, government regulations, and protocols.
• Complete system entries regarding claim/encounter information and support quality initiatives.

Job description

Humana is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. This remote role reviews medical claims against records to ensure CPT/HCPCS codes are accurate and aligned with guidelines.

Candidates should have CPC/COC/CCS/ROCC/RHIA/RHIT certification with 3+ years post-cert experience and knowledge of chemotherapy/infusion coding. You will use encoders, perform CPT/HCPCS reviews, and participate in process improvements while protecting PHI.