LogoFresh Jobs Ahead
Humana
Humana
H1B Visa SponsorHealthcareHealthcare InsuranceInsurance
Humana is a healthcare and health insurance company focused on improving health outcomes for individuals, communities, and the broader healthcare system. Its work includes Medicare Advantage HMO, PPO, and PFFS plans serving populations such as seniors and military members. Humana also emphasizes an inclusive workplace built around belonging, mutual respect, and opportunities for employees to contribute to the company’s health-focused mission.
LinkedIn
Company Jobs

Nurse Auditor – Inpatient Coding (Remote, United States)

Humana is seeking a remote Nurse Auditor to validate inpatient clinical documentation, diagnosis coding, HCC risk, and provider billing. The role also involves identifying audit root causes and recommending corrective actions.

USUnited States
$78,400 – $107,800 / year
RemoteFull-timeJuniorMiddleNo degree requiredEnglish RequiredAuditor

Description

  • Conduct clinical audits and validation reviews to confirm that medical-record documentation and diagnosis coding are complete, accurate, and compliant.
  • Interpret medical records and validate documentation to capture all applicable codes.
  • Identify members associated with high-risk CMS Hierarchical Condition Categories (HCCs).
  • Refer appropriate cases for annual follow-up by disease management, case management, and primary care teams.
  • Analyze the underlying causes of audit findings and submit recommendations for change management.
  • Evaluate provider coding and billing using clinical and coding expertise.
  • Apply department, segment, and organizational strategies and operating objectives within related business areas.
  • Use sound judgment to determine work methods in occasionally ambiguous situations with limited direction.
  • Follow established policies, guidelines, and procedures.
  • Work remotely during standard Monday-to-Friday business hours for eight hours each day.
  • Occasionally travel to Humana offices for training or meetings.

Requirements

  • Hold an active Registered Nurse (RN) license in the state of residence.
  • Have at least two consecutive years of acute inpatient hospital experience in a critical or intensive care setting within the past five years, excluding pediatric and neonatal care.
  • Alternatively, have at least two years of DRG inpatient auditing experience.
  • Possess in-depth knowledge of complex medical diagnoses, including sepsis, pneumonia, acidosis, renal failure, encephalopathy, CVA, DKA, and MI.
  • Demonstrate advanced proficiency with Microsoft Office applications, including Word and Excel.
  • Bring strong writing, editing, interpersonal, planning, teamwork, and communication skills.
  • Demonstrate sound judgment and discretion when handling and sharing information.
  • Work independently while effectively managing the assigned workload.
  • Demonstrate customer-service orientation, professionalism, flexibility, dependability, willingness to learn, and commitment to excellence and the nursing profession.
  • A bachelor's degree in a relevant field is preferred.
  • An inpatient coding certification such as RHIA, RHIT, CCS, CIS, or CIC is preferred.
  • Experience with inpatient coding claims is preferred.
  • Knowledge of prospective payment methodologies and DRG auditing experience are preferred.
  • Clinical documentation improvement knowledge or CDE/CDEI certification is preferred.
  • Meet work-from-home internet requirements of at least 25 Mbps download and 10 Mbps upload.
  • Maintain a dedicated workspace with no ongoing interruptions to safeguard member PHI and HIPAA information.

Benefits

  • Bonus incentive plan tied to company and/or individual performance.
  • Medical, dental, and vision coverage.
  • 401(k) retirement savings plan.
  • Paid time off.
  • Company and personal holidays.
  • Paid parental and caregiver leave.
  • Short- and long-term disability coverage.
  • Life insurance.
  • Internet expense reimbursement for California, Illinois, Montana, or South Dakota associates working from home.
  • Telephone equipment for home-based or hybrid home/office associates.
  • Remote work-from-home arrangement.
  • Home office internet service support, subject to applicable requirements.

Related Jobs