Remote Nurse Auditor: Clinical Records & Coding Expert

Humana Inc; Madison (WI); 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 accurate coding and compliant documentation for optimal reimbursement. The role requires independent judgement, strong coding knowledge, and the ability to interpret complex diagnoses.

The position is remote with occasional travel to Humana offices for training or meetings. Strong MS Office skills, effective communication, and a track record in inpatient auditing are essential for

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 (e.g., Sepsis, Pneumonia, MI).
• Advanced knowledge of MS Office (Word, Excel).
• Excellent writing, editing, interpersonal, planning, teamwork, and communication skills.

Responsibilities

• Audit/validate medical records to ensure complete, compliant, accurate documentation for reimbursement.
• Identify high-risk CMS HCCs and refer cases for follow-up care as appropriate.
• Perform root cause analysis of audit findings and propose changes.
• Review provider codes and billing using clinical and coding experience.
• Make decisions with minimal direction and align with department strategy.

Skills

RN license

2+ years inpatient care

Complex diagnoses knowledge

MS Office

Writing skills

Independent work

Customer service

Education

Bachelor's Degree in relevant field

Inpatient coding certification (AHIMA or AAPC)

Tools

MS Office (Word, Excel)

Job description

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical records to ensure accurate coding and compliant documentation for optimal reimbursement. The role requires independent judgement, strong coding knowledge, and the ability to interpret complex diagnoses.

The position is remote with occasional travel to Humana offices for training or meetings. Strong MS Office skills, effective communication, and a track record in inpatient auditing are essential for