Remote Nurse Auditor: Clinical Coding & Compliance

Humana Inc; Northern (KY); Hybrid; USD 78,000 - 108,000; Full time

Benefits offered by this job

Remote work

Travel for training

Bonus incentive program

Job summary

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical records and coding. Remote nationwide role; occasional office visits may be required.

You will interpret documentation to ensure complete, compliant coding and identify high-risk cases for follow-up care. The role requires an active RN license, 2+ years of inpatient care, and strong knowledge of complex diagnoses, with excellent writing and communication skills.

Qualifications

• Active RN license in the state of residence.
• Minimum of 2 consecutive years acute inpatient hospital care experience in the last 5 years.
• Strong knowledge of complex medical diagnoses (e.g., sepsis, MI).
• Advanced writing, editing and interpersonal skills.

Responsibilities

• Perform clinical audit/validation to ensure complete and accurate coding for services rendered.
• Identify high-risk CMS HCC cases and refer for follow-up care as appropriate.
• Conduct root-cause analyses of audit findings and propose changes.
• Apply clinical and coding experience to reviews of provider codes and billing.

Skills

RN license

Inpatient care

Coding knowledge

Clinical documentation

MS Office

Communication

Education

Bachelor's degree preferred

AHIMA/AAPC inpatient coding certification

Tools

MS Office

Word

Excel

Job description

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical records and coding. Remote nationwide role; occasional office visits may be required.

You will interpret documentation to ensure complete, compliant coding and identify high-risk cases for follow-up care. The role requires an active RN license, 2+ years of inpatient care, and strong knowledge of complex diagnoses, with excellent writing and communication skills.