Remote Nurse Auditor: Clinical Coding & Compliance

Humana; United States; Remote; USD 78,000 - 108,000; Full time

Job summary

Humana is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical documentation and coding to ensure accuracy and compliance, supporting optimal reimbursement. Remote role with occasional travel to Humana offices for training or meetings.

Requirements include an active RN license, 2+ years inpatient acute care or DRG auditing experience, strong knowledge of complex diagnoses, and advanced MS Office skills. Excellent writing and communication are essential.

Qualifications

• Active RN license in the state of residence.
• Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years.
• In-depth knowledge of complex medical diagnoses (Sepsis, Pneumonia, Renal Failure, MI, etc).
• Advanced knowledge of MS Office (Word, Excel, etc).
• Excellent writing, editing, interpersonal, planning, teamwork, and communications skills.
• Demonstrated ability to exercise sound judgment and discretion in handling information.
• Ability to work independently and manage workload.
• Customer-service focused and professional.

Responsibilities

• Perform clinical audit/validation to ensure complete, compliant and accurate medical record documentation and coding.
• Identify high-risk CMS HCC cases and refer for annual follow-up by disease/case management or primary care.
• Conduct root-cause analyses of audit findings and submit change-management recommendations.
• Review provider codes and billing using clinical and coding expertise.
• Understand department and organizational strategy and align work with objectives.
• Make independent decisions on work methods, with guidance as needed.
• Follow established guidelines and procedures.

Skills

RN license

Critical care experience

Medical coding knowledge

MS Office proficiency

Strong written communication

Independent working style

Customer service orientation

Education

Bachelor’s Degree in a relevant field

Inpatient coding certification (AHIMA or AAPC)

Tools

Microsoft Excel

Job description

Humana is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical documentation and coding to ensure accuracy and compliance, supporting optimal reimbursement. Remote role with occasional travel to Humana offices for training or meetings.

Requirements include an active RN license, 2+ years inpatient acute care or DRG auditing experience, strong knowledge of complex diagnoses, and advanced MS Office skills. Excellent writing and communication are essential.