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Job Description Summary
The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and coding for services rendered is complete, compliant, and accurate to support optimal reimbursement. You will report to the Supervisor, Payment Integrity.

As the Nurse Auditor 2 you will

• Validate and interpret medical documentation to ensure capture of all relevant coding.

• Apply clinical and coding experience to conduct reviews of provider codes and billing

• Focus on laboratory services and involve medical auditing of genetics, drug testing and infection agent testing claims that require interpretation and independent determination of the appropriate courses of action.

• Reviews involve the review of Fraud Waste and abuse case determinations and require documentation and follow up regarding the result of these cases.

Use your skills to make an impact
 

Required Qualifications

• Active RN license

• Experience with outpatient CPT/HCPCS codes

• Experience with review of medical records

• 2+ years clinical experience

• 3+ years' experience in the health industry

Preferred Qualifications

• Certified Professional Coder (CPC)

• Familiar with lab or genetic testing

• Fraud, Waste, and Abuse Investigative experience.

• Clinical auditing experience

• Bachelor's degree

• Familiarity with CMS and Humana regulatory policies

• Knowledge of general lab billing

Additional Information

WORK STYLE: Remote/work at home.

WORK HOURS: Business hours are Monday-Friday, expected to work 8 hours/day, 5 days/week

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Work at Home

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

#LI-BB1

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$59,300 - $80,900 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.

Application Deadline: 04-17-2026

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easi