Remote Nurse Auditor: Medical Records & Coding Specialist

Humana Inc; Honolulu (HI); Remote; USD 78,000 - 108,000; Full time

Benefits offered by this job

Telephone equipment provided

Internet stipend (select states)

Work from home flexibility

Job summary

Humana, Inc. is seeking a Nurse Auditor 2 to perform clinical audit/validation of medical records and coding to ensure complete, compliant documentation and accurate reimbursement. The role requires interpreting and determining actions with minimal supervision.

This remote position may require occasional travel to Humana offices for training and meetings; typical hours are 40 per week with pay range shown, and eligibility for a bonus plan.

Qualifications

• Active RN license in the resident state.
• 2 consecutive years acute inpatient hospital care experience in critical care within last 5 years (not pediatrics or neonatal).
• Deep knowledge of complex diagnoses (e.g., Sepsis, Pneumonia, Renal failure, MI).
• Advanced MS Office knowledge (Word, Excel).
• Excellent writing, editing, interpersonal, planning, teamwork and communication skills.
• Ability to exercise sound judgment and discretion in handling information.
• Ability to work independently and manage workload.
• Customer-service oriented and professional.

Responsibilities

• Validate and interpret medical documentation to ensure full coding capture.
• Identify high-risk CMS HCCs and refer cases for follow-up care.
• Analyze audit findings and propose change management actions.
• Apply clinical and coding experience to reviews of provider codes and billing.

Skills

RN license

Medical diagnoses knowledge

MS Office

Writing & Communication

Judgment & discretion

Independence

Customer service

Education

Bachelor’s Degree

Inpatient coding certification (AHIMA/AAPC)

Inpatient coding experience

DRG auditing experience

CDI knowledge (CDE/CDEI)

Job description

Humana, Inc. is seeking a Nurse Auditor 2 to perform clinical audit/validation of medical records and coding to ensure complete, compliant documentation and accurate reimbursement. The role requires interpreting and determining actions with minimal supervision.

This remote position may require occasional travel to Humana offices for training and meetings; typical hours are 40 per week with pay range shown, and eligibility for a bonus plan.