Medical Coding Auditor

Become a part of our caring community and help us put health first

The Medical Coding Auditor reviews medical claims submitted against medical records provided to ensure correct coding guidelines are met (e.g., ICD-10-CM, CPT, HCPCS). The work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The auditor contributes to overall cost reduction by increasing the accuracy of provider contract payments in payer systems and ensuring correct claims payment for appropriate CPT/HCPCS code assignments.

Responsibilities include analyzing, entering and manipulating database data, responding to or clarifying internal requests for medical information, and making decisions regarding work methods with minimal direction.

As a Medical Coding Auditor for the Hospital Outpatient/APC Coding Team you will:

• Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
• Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to APC and Hospital Outpatient Facility coding
• Utilize encoders and various coding resources
• Perform CPT/HCPCS Procedure reviews
• Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
• Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
• Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
• Complete appropriate system(s) entry regarding claim/encounter information
• Support and participate in process and quality improvement initiatives

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well‑being. We also provide excellent professional development & continued education.

100% work at home/remote

Typical business hours are Monday‑Friday, 8 hours/day, 5 days/week – some flexibility might be possible, depending on business needs.

• 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 & coding from operative reports
• Chemotherapy/Therapeutic Infusion experience
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
• Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities
• Comfortable working in a production‑based work environment
• Ability to work independently and manage workload
• Strong written and verbal communication skills; strong analytical, organizational and time‑management skills
• Working knowledge of Microsoft Office Programs (Word, Excel)

• 5+ years prior coding experience
• Minimum of 3 years post‑certification experience reading and interpreting claims
• Outpatient facility auditing experience
• Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology
• Ambulatory Payment Classification (APC) coding experience
• Radiation Oncology coding experience
• Experience in prospective payment methodologies
• Experience with the Claims Life Cycle including Accounts Receivable
• 3M Coder software experience

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense.
• Humana will provide Home or Hybrid…