Nurse Medical Coder

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Perform detailed medical record reviews to ensure accurate ICD-10-CM coding, risk adjustment capture, and alignment with CMS-HCC (e.g., V24/V28) models • Validate diagnosis coding and ensure documentation meets compliance standards • Identify and escalate coding trends and documentation gaps • Serve as a coding subject matter expert supporting CST workflows, including PDV, chart review prioritization, and provider outreach • Partner with clinical and operational teams to drive coding accuracy • Engage and partner with physicians, physician groups, and market leadership to improve documentation and coding practices • Deliver targeted coder education focused on compliance, coding specificity and accuracy • Analyze coding trends, audit findings, and performance metrics to identify opportunities for improvement • Develop actionable insights and recommendations to improve coding accuracy • Support continuous quality improvement processes across CST and stakeholders • Exercise judgment in selecting methodologies and approaches to meet program objectives

🎯 Requirements

• Active RN license (BSN preferred) or equivalent clinical licensure • Certified Professional Coder (CPC), CRC, CCS • Strong knowledge of ICD-10-CM coding guidelines, risk adjustment methodologies, and documentation standards • Experience with medical record review, coding validation, and audit processes • Proficiency in analyzing and interpreting data trends and applying continuous quality improvement processes • Excellent written and verbal communication skills • Strong proficiency in Microsoft Office tools (Word, Excel, Access) • Demonstrated ability to work independently and manage multiple priorities

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) • short-term and long-term disability • life insurance and many other opportunities