Remote RN Auditor: Medical Records & Coding Specialist

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

Job summary

Humana is seeking a Nurse Auditor 2 to perform clinical audit/validation of medical records to ensure accurate diagnosis coding and compliant billing for optimal reimbursement. The role involves interpreting documentation, identifying high-risk HCCs, and recommending improvements.

The position is remote with occasional travel to Humana offices for training or meetings; typical hours are Monday–Friday, with start times in the home time zone. Requires RN license and inpatient care experience.

Qualifications

• Active RN license in the state of residence.
• Minimum 2 consecutive years acute inpatient hospital care in critical, intensive care setting within the last 5 years.
• In-depth knowledge of complex medical diagnoses (sepsis, pneumonia, acidosis, renal failure, 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 information.
• Ability to work independently and manage workload.
• Customer-service focused and professional.
• Bachelor’s degree preferred.
• Inpatient coding certification (AHIMA or AAPC – ex: RHIA, RHIT, CCS, CIS, CIC).
• Inpatient coding claim experience.
• Prospective payment methodologies, DRG auditing experience.
• Clinical documentation improvement knowledge (CDE, CDEI).

Responsibilities

• Perform clinical audit/validation to ensure documentation and coding are complete and accurate for optimal reimbursement.
• Validate and interpret medical documentation to capture all relevant coding and identify high-risk HCC cases.
• Refer cases for follow-up care by disease management or primary care teams as appropriate.
• Identify root causes of audit findings and submit recommendations for change management.
• Apply clinical and coding experience to review provider codes and billing.
• Follow guidelines and procedures while making autonomous decisions when needed.

Skills

RN license

ICU/CCU experience

Medical diagnoses knowledge

MS Office

Writing & communication

Judgment & discretion

Independent work

Customer service

Education

Bachelor’s degree preferred

Inpatient coding certification (RHIA, RHIT, CCS, CIS, CIC)

Inpatient coding experience

DRG auditing experience

CDI knowledge (CDE/CDEI)

Tools

MS Office

Job description

Humana is seeking a Nurse Auditor 2 to perform clinical audit/validation of medical records to ensure accurate diagnosis coding and compliant billing for optimal reimbursement. The role involves interpreting documentation, identifying high-risk HCCs, and recommending improvements.

The position is remote with occasional travel to Humana offices for training or meetings; typical hours are Monday–Friday, with start times in the home time zone. Requires RN license and inpatient care experience.