Remote Nurse Auditor: Clinical Coding & Compliance

Humana Inc; Lansing (MI); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit/validation of medical documentation and coding to support accurate reimbursement. You will identify high-risk cases, refer for follow-up care, and recommend changes based on clinical and coding expertise.

Remote work with occasional travel to Humana offices for training may be required. Typical hours are Monday–Friday, with start times between 6 AM and 9 AM in your home time zone.

Qualifications

• Active RN license in the state of residence.
• Minimum of 2 consecutive years acute inpatient hospital care experience in critical care within the last 5 years.
• In-depth knowledge of complex medical diagnoses.
• Advanced knowledge of MS Office and strong writing/editing skills.
• Excellent interpersonal, planning, teamwork and communications abilities.
• Good judgment, discretion and ability to work independently.
• Customer-service oriented and professional conduct.

Responsibilities

• Audit and validate medical documentation to ensure complete and accurate coding.
• Identify high-risk CMS HCC cases and refer for annual follow-up care as needed.
• Analyze root causes of audit findings and submit recommended changes.
• Review provider codes and billing using clinical and coding expertise.
• Align work with department strategy and established guidelines.

Skills

RN license

Inpatient experience

Critical care knowledge

Complex medical diagnoses

Writing & communication

Independent judgment

Customer service

Education

Bachelor's degree preferred

Inpatient coding certification (RHIA/RHIT/CCS/CIS/CIC)

Tools

MS Office

Job description

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit/validation of medical documentation and coding to support accurate reimbursement. You will identify high-risk cases, refer for follow-up care, and recommend changes based on clinical and coding expertise.

Remote work with occasional travel to Humana offices for training may be required. Typical hours are Monday–Friday, with start times between 6 AM and 9 AM in your home time zone.