Medical Coding Auditor

Humana

2d•$59,300 - $80,900•Remote

About The Position

The Medical Coding Auditor reviews medical claims against medical records to ensure accurate coding under ICD-10-CM, CPT, HCPCS, Ambulatory Payment Classification (APC), and outpatient facility coding guidelines. The role helps reduce costs by improving provider contract payment accuracy and ensuring claims are paid correctly for assigned CPT/HCPCS codes. Work includes interpreting documentation, entering and manipulating database information, responding to internal requests for medical information, and making independent decisions within established guidelines. The auditor works with minimal direction and contributes to process and quality improvement initiatives. This is a remote, work-at-home position on the Outpatient Facility/APC Coding Team. Typical hours are Monday through Friday, eight hours per day, with some flexibility depending on business needs. Occasional travel to Humana offices for training or meetings may be required. Associates need a dedicated workspace that protects member PHI/HIPAA information and a reliable internet connection meeting the stated speed requirements. The position is eligible for a bonus incentive plan. Humana offers professional development and continued education, along with benefits including medical, dental and vision coverage, a 401(k) plan, paid time off and holidays, paid parental and caregiver leave, disability coverage, and life insurance.

Requirements

CPC, COC, CCS, ROCC, RHIA, or RHIT certification with at least 3 years of post-certification experience.
At least 3 years of post-certification experience with outpatient specialty surgeries and procedures.
Strong knowledge of CPT/HCPCS coding.
Experience reading and coding operative reports.
Chemotherapy and/or therapeutic infusion experience.
Ability to exercise sound judgment and discretion when handling and disseminating information.
Strong attention to detail; ability to work independently, determine appropriate courses of action, and handle multiple priorities.
Comfort working in a production-based environment and managing workload independently.
Strong written and verbal communication, analytical, organizational, and time-management skills.
Working knowledge of Microsoft Office programs, including Word and Excel.
Ability to meet the work-at-home internet requirements: minimum 25 Mbps download and 10 Mbps upload; satellite, cellular, or microwave connections require leadership approval.
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

5 or more years of prior coding experience.
Outpatient facility auditing experience.
Coding or auditing experience in Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology, or Outpatient Itemized Bill reviews.
Ambulatory Payment Classification (APC) coding experience.
Radiation Oncology coding experience.
Experience with prospective payment methodologies.
Experience with the Claims Life Cycle, including Accounts Receivable.
3M Coder software experience.

Responsibilities

Verify the accuracy, completeness, specificity, and appropriateness of procedure codes based on services rendered.
Review medical documentation for clinical indicators and confirm procedures meet clinical criteria and applicable APC and outpatient facility coding guidelines.
Use encoders and other coding resources.
Perform CPT/HCPCS procedure reviews.
Conduct peer reviews for coding-guideline compliance and provide reports as needed.
Maintain patient and physician confidentiality and follow federal, state, and hospital requirements for release of information.
Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulations, and protocols.
Enter claim and encounter information into appropriate systems.
Support and participate in process and quality improvement initiatives.
Analyze, enter, and manipulate database information, and respond to or clarify internal requests for medical information.

Benefits

Medical insurance
Dental insurance
Vision insurance
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability coverage
Life insurance
Professional development and continued education
Bonus incentive plan
Telephone equipment appropriate to the position's business requirements
Bi-weekly internet expense payment for associates who live and work from home in California, Illinois, Montana, or South Dakota