Remote RN Nurse Auditor: Clinical Coding & Audit

Humana Inc; Santa Fe (NM); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Nurse Auditor 2 working remotely with occasional travel for training or meetings. The role focuses on clinical audit/validation of medical documentation and coding to ensure accurate reimbursement.

The candidate should have an active RN license, 2+ years inpatient critical care experience, and strong MS Office skills. This position requires independent work, excellent writing and communication abilities, and adherence to established guidelines.

Qualifications

• Active RN license in the state of residence.
• 2+ years acute inpatient critical care experience in the last 5 years (not pediatrics or neonatal).
• In-depth knowledge of complex medical diagnoses (e.g., Sepsis, Pneumonia, Renal Failure, MI).
• Advanced knowledge of MS Office (Word, Excel, etc).
• Excellent writing, editing, interpersonal, planning, teamwork, and communications skills.
• Ability to work independently and manage workload.
• Customer-service oriented and professional disposition.

Responsibilities

• Perform clinical audit/validation to ensure complete, compliant documentation for optimal reimbursement.
• Identify high-risk CMS HCCs and refer cases for annual follow-up care by disease management, case management, and primary care providers as appropriate.
• Identify root cause analysis of audit findings and submit recommendations for change management.
• Apply clinical and coding experience to reviews of provider codes and billing.
• Follow established guidelines and procedures.

Skills

RN license

Inpatient ICU experience

Coding knowledge

Writing & communication

Independent work

Customer service

Education

Bachelor's degree preferred

Tools

MS Office (Word, Excel)

Job description

Humana Inc. is seeking a Nurse Auditor 2 working remotely with occasional travel for training or meetings. The role focuses on clinical audit/validation of medical documentation and coding to ensure accurate reimbursement.

The candidate should have an active RN license, 2+ years inpatient critical care experience, and strong MS Office skills. This position requires independent work, excellent writing and communication abilities, and adherence to established guidelines.