Remote Medical Coding Auditor - Outpatient APC Specialist

Humana; Phoenix (AZ); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work option

Travel for training occasionally

Job summary

Humana is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will verify and review codes, analyze documentation, and ensure accurate CPT/HCPCS coding while supporting QA initiatives.

This remote role may require occasional travel to Humana offices for training or meetings. Qualified candidates have CPC/COC/CCS/ROCC/RHIA/RHIT with 3+ years post-certification, strong CPT/HCPCS knowledge, and experience with outpatient surgeries and chemotherapy infusion coding.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with minimum 3 years post-certification experience.
• Strong CPT/HCPCS coding knowledge.
• Experience reading and coding from operative reports.
• Chemotherapy or Therapeutic Infusion coding experience.
• Attention to detail and ability to work independently with multiple priorities.
• Familiarity with Microsoft Word and Excel.

Responsibilities

• Verify and ensure 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 (APC/Outpatient).
• Utilize encoders and coding resources.
• Perform CPT/HCPCS procedure reviews.
• Conduct peer reviews to ensure coding guideline compliance and provide reports as needed.
• Maintain patient and physician confidentiality per HIPAA and related guidelines.
• Maintain current knowledge of ICD-10-CPT coding guidelines, regulations, and protocols.
• Complete system entries for claims/encounters.
• Support process and quality improvement initiatives.

Skills

CPC Certification

COC Certification

CCS Certification

ROCC Certification

RHIA/RHIT Certification

CPT/HCPCS Coding

Operative Reports Coding

Chemotherapy Infusion Coding

MS Office (Word & Excel)

3M Coder Software

Tools

3M Coder software

Job description

Humana is seeking a Medical Coding Auditor for the Outpatient Facility/APC Coding Team. You will verify and review codes, analyze documentation, and ensure accurate CPT/HCPCS coding while supporting QA initiatives.

This remote role may require occasional travel to Humana offices for training or meetings. Qualified candidates have CPC/COC/CCS/ROCC/RHIA/RHIT with 3+ years post-certification, strong CPT/HCPCS knowledge, and experience with outpatient surgeries and chemotherapy infusion coding.