Remote Medical Coding Auditor | Outpatient APC Specialist

Humana; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

Humana seeks a Medical Coding Auditor for its Outpatient Facility/APC Coding Team. This remote position involves reviewing claims against medical records, ensuring accurate CPT/HCPCS coding, and contributing to cost reduction through precise payments.

You will work with zero-day travel and standard business hours, applying coding guidelines, mitigating discrepancies, and supporting quality initiatives across payer systems.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience
• 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
• Ability to exercise solid judgment, work independently, and manage multiple priorities

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 for APC/outpatient coding
• Utilize encoders and various coding resources
• Perform CPT/HCPCS procedure reviews
• Conduct peer reviews and provide reports as needed
• Maintain patient and physician confidentiality and follow all guidelines for information release
• Maintain current knowledge of ICD-10 and CPT coding guidelines and regulations
• Complete system entry for claim/encounter information
• Support process and quality improvement initiatives

Skills

CPT/HCPCS coding

Operative reports coding

Microsoft Office (Word, Excel)

Independent work ability

Attention to detail

Education

CPC/COC/CCS/RHIA/RHIT Certification

Tools

3M Coder software

Job description

Humana seeks a Medical Coding Auditor for its Outpatient Facility/APC Coding Team. This remote position involves reviewing claims against medical records, ensuring accurate CPT/HCPCS coding, and contributing to cost reduction through precise payments.

You will work with zero-day travel and standard business hours, applying coding guidelines, mitigating discrepancies, and supporting quality initiatives across payer systems.