Remote Nurse Auditor: Clinical Coding & Compliance

Humana Inc; Richmond (VA); 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 record documentation and diagnosis coding to ensure complete, compliant and accurate coding for optimal reimbursement.

The Nurse Auditor 2 will identify high-risk CMS HCCs, interpret documentation, and refer cases for annual follow-up care by disease management, case management and primary care providers as appropriate. This remote role may require occasional travel for training or meetings.

Qualifications

• Active RN license in the state of residence.
• 2 consecutive years acute inpatient hospital care or 2 years DRG inpatient auditing in the last 5 years.
• In-depth knowledge of complex medical diagnoses (sepsis, pneumonia, DKA, MI, etc.).
• Advanced knowledge of MS Office (Word, Excel, etc).
• Excellent writing, editing, interpersonal, planning, teamwork, and communications skills.
• Demonstrated ability to exercise solid judgment and discretion.

Responsibilities

• Validate and interpret medical documentation to ensure proper capture of coding.
• Identify members with high-risk CMS HCCs and refer cases for annual follow-up care.
• Identify root causes of audit findings and submit change-management recommendations.

Skills

RN license

Critical care

MS Office

Communication skills

Independent work

Education

Bachelor’s degree

Inpatient coding certification

Tools

MS Office

Job description

Humana, Inc. is seeking a Nurse Auditor 2 to perform clinical audit/validation of medical record documentation and diagnosis coding to ensure complete, compliant and accurate coding for optimal reimbursement.

The Nurse Auditor 2 will identify high-risk CMS HCCs, interpret documentation, and refer cases for annual follow-up care by disease management, case management and primary care providers as appropriate. This remote role may require occasional travel for training or meetings.