Remote RN Nurse Auditor: Clinical Coding & Audit Specialist

Humana Inc; Phoenix (AZ); Remote; USD 78,000 - 108,000; Full time

Job summary

Humana Inc. is seeking a Nurse Auditor 2 for a remote role that reviews clinical documentation and coding to ensure complete, compliant, and accurate billing. You will interpret medical records, identify high-risk cases, and suggest improvements.

The role requires RN licensure and inpatient experience, with travel for training occasional. The position supports standard business hours with potential travel to Humana offices for training or meetings.

Qualifications

• Active RN license in the state of residence.
• Minimum of 2 consecutive years acute inpatient hospital care experience in ICU/CCU/PCU or equivalent within last 5 years.
• In-depth knowledge of complex medical diagnoses (e.g., Sepsis, MI, DKA).
• Advanced knowledge of MS Office.
• Excellent written and verbal communication skills.
• Ability to exercise sound judgment independently.
• Strong organizational and time-management skills.

Responsibilities

• Validate and interpret medical documentation for accurate coding and billing.
• Identify high-risk CMS HCC cases and refer them for follow-up care as needed.
• Analyze audit findings and propose appropriate change management actions.
• Apply clinical and coding expertise to provider codes and billing reviews.
• Maintain alignment with department and organizational objectives.

Skills

RN license

Inpatient hospital care experience

Medical diagnoses knowledge

MS Office

Writing and editing

Independent work

Customer service

Education

Bachelor’s Degree (preferred)

Inpatient coding certification (AHIMA/AAPC)

Tools

MS Office

Job description

Humana Inc. is seeking a Nurse Auditor 2 for a remote role that reviews clinical documentation and coding to ensure complete, compliant, and accurate billing. You will interpret medical records, identify high-risk cases, and suggest improvements.

The role requires RN licensure and inpatient experience, with travel for training occasional. The position supports standard business hours with potential travel to Humana offices for training or meetings.