Remote Nurse Auditor Clinical Documentation & Coding

Humana Inc; Juneau (AK); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical records to ensure complete, compliant, and accurate coding for optimal reimbursement. The role requires interpretation and independent action in many situations.

This remote position includes travel for training or meetings; typical hours are structured and self-directed, with responsibilities emphasizing precise coding reviews and collaboration with care teams.

Qualifications

• Active Registered Nurse (RN) license in the state they reside.
• Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not pediatrics or neonatal).
• In depth knowledge and critical understanding of complex medical diagnoses including, but not limited to, Sepsis (including end-organ failure), Pneumonia, Acidosis, Renal Failure, Encephalopathy, CVA, 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 in handling and disseminating information
• Ability to work independently and manage workload
• Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession

Responsibilities

• Validate and interpret medical documentation to ensure capture of all relevant coding.
• Identify members with high risk CMS Hierarchical Condition Categories (HCC) and refer cases for follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention.
• Identify the root cause analysis of audit findings and submit recommendations for appropriate change management.
• Apply clinical and coding experience to conduct reviews of provider codes and billing.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Skills

RN license

Inpatient hospital care

Complex diagnoses knowledge

Writing/editing

Judgment/ discretion

Independent work

Customer service

Education

Bachelor’s Degree preferred

Inpatient coding certification

Inpatient coding claims experience

DRG auditing experience

Clinical documentation improvement knowledge

Tools

MS Office

Job description

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical records to ensure complete, compliant, and accurate coding for optimal reimbursement. The role requires interpretation and independent action in many situations.

This remote position includes travel for training or meetings; typical hours are structured and self-directed, with responsibilities emphasizing precise coding reviews and collaboration with care teams.