Unknown Company is hiring a Nurse Auditor 2

Humana is hiring a Nurse Auditor 2 to perform clinical audit and validation processes for medical record documentation and diagnosis coding. In this role, you will ensure documentation is complete, compliant, and accurate to support optimal reimbursement, working within a company committed to putting health first.

What You'll Do

• Perform clinical audit and validation processes to ensure medical record documentation and diagnosis coding is complete, compliant, and accurate.
• Validate and interpret medical documentation to ensure capture of all relevant coding.
• Conduct clinical validation reviews of inpatient medical records to validate billed diagnoses.
• Understand department, segment, and organizational strategy and operating objectives.
• Make decisions regarding your own work methods, occasionally in ambiguous situations, requiring minimal direction.
• Follow established guidelines and procedures.

What We're Looking For

• Active Registered Nurse (RN) license in your state of residence.
• Minimum of 2 consecutive years of acute inpatient hospital care experience in a critical or intensive care setting within the last 5 years (e.g., ICU, CCU, PCU, med-surg/adult units).
• OR a minimum of 2 years of DRG Inpatient auditing experience.
• In-depth knowledge and critical understanding of complex medical diagnoses (e.g., Sepsis, Pneumonia, Renal Failure, CVA, MI).
• Advanced knowledge of MS Office (Word, Excel, etc.).
• Excellent writing, editing, interpersonal, planning, teamwork, and communication skills.
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information.
• Ability to work independently and manage your workload.
• A customer-service focus and professionalism, flexibility, dependability, a desire to learn, and a commitment to excellence.

Nice to Have

• Bachelor’s Degree in a relevant field.
• Inpatient coding certification from AHIMA or AAPC (e.g., RHIA, RHIT, CCS, CIS, CIC).
• Inpatient coding claim experience.
• Experience with prospective payment methodologies and DRG auditing.
• Clinical documentation improvement knowledge (CDE, CDEI certification).

Technical Stack

• MS Office (Word, Excel, etc.)

Benefits & Compensation

• Compensation range: $78,400 - $107,800 per year.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave.
• Short-term and long-term disability insurance.
• Life insurance.
• Bi-weekly internet expense payment for associates in California, Illinois, Montana, or South Dakota.
• Telephone equipment provided.
• Bonus incentive plan based on company and/or individual performance.

Work Mode

This is a fully remote position (Work at Home).

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.