Remote RN Auditor — Medical Coding & Compliance

Humana Inc; Jackson (MS); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. seeks a Nurse Auditor 2 to perform clinical audit/validation of medical records and coding to ensure complete, compliant, and accurate documentation for optimal reimbursement. You will interpret complex diagnoses and participate in case management referrals as needed.

Remote position with occasional travel to Humana offices for training or meetings. Typical hours are 8 hours/day, Monday–Friday, with start times between 6AM and 9AM in the home time zone.

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 (e.g., Sepsis, pneumonia, renal failure).
• Advanced knowledge of MS Office (Word, Excel).
• Excellent writing, editing, interpersonal, planning and communication skills.
• Ability to exercise solid judgment and discretion in handling information.
• Ability to work independently and manage workload.
• Customer-service oriented and professional in conduct.

Responsibilities

• Perform clinical audit/validation to ensure complete and compliant documentation and accurate coding for optimal reimbursement.
• Identify high risk CMS HCCs and refer cases for annual follow-up by disease/case management and primary care.
• Analyze audit findings, identify root causes, and submit recommendations for change management.
• Apply clinical and coding knowledge to review provider codes and billing.
• Follow established guidelines and procedures.

Skills

RN license

Inpatient experience

Medical diagnoses knowledge

MS Office

Writing & communication

Judgment & discretion

Independent work

Customer service

Education

Bachelor’s Degree in relevant field

Inpatient coding certification

Clinical documentation improvement knowledge

Inpatient coding experience

Tools

Job description

Humana Inc. seeks a Nurse Auditor 2 to perform clinical audit/validation of medical records and coding to ensure complete, compliant, and accurate documentation for optimal reimbursement. You will interpret complex diagnoses and participate in case management referrals as needed.

Remote position with occasional travel to Humana offices for training or meetings. Typical hours are 8 hours/day, Monday–Friday, with start times between 6AM and 9AM in the home time zone.