Remote Outpatient APC Coding Auditor

Humana Inc; Northern (KY); Hybrid; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Bonus incentive plan

Job summary

Humana Inc. is seeking a Medical Coding Auditor for its Outpatient Facility/APC Coding Team. This remote role reviews claims, ensures CPT/HCPCS compliance, and interprets medical records to support accurate payments. Occasional travel to Humana offices may be required for training or meetings.

The ideal candidate holds a CPC/COC/CCS/ROCC/RHIA/RHIT certification with at least 3 years of post-certification experience, and has strong CPT/HCPCS knowledge and experience with operative reports.

Qualifications

• CPC, COC, CCS, ROCC, RHIA or RHIT certification with minimum 3 years post-certification experience.
• Strong CPT/HCPCS knowledge and outpatient coding experience.
• Experience reading and coding from operative reports.
• Experience with chemotherapy or therapeutic infusion coding.
• Ability to work independently in a production-based environment.

Responsibilities

• Verify accuracy and specificity of procedure codes based on services rendered.
• Review medical documentation to ensure clinical criteria and coding guidelines are met.
• Utilize encoders and coding resources; perform CPT/HCPCS reviews.
• Conduct peer reviews and provide reports; maintain patient confidentiality and HIPAA compliance.
• Maintain knowledge of ICD-10 and CPT guidelines; make independent decisions as needed.
• Enter claim/encounter data into systems; support process and quality improvements.

Skills

CPT/HCPCS coding

Medical coding auditing

Operative report review

Outpatient coding

Attention to detail

Microsoft Word/Excel

Tools

3M Coder

Job description

Humana Inc. is seeking a Medical Coding Auditor for its Outpatient Facility/APC Coding Team. This remote role reviews claims, ensures CPT/HCPCS compliance, and interprets medical records to support accurate payments. Occasional travel to Humana offices may be required for training or meetings.

The ideal candidate holds a CPC/COC/CCS/ROCC/RHIA/RHIT certification with at least 3 years of post-certification experience, and has strong CPT/HCPCS knowledge and experience with operative reports.