Nurse Medical Coder

Humana

Nurse Medical Coder supporting Humana's Clinical Support Team initiatives for accurate coding practices. Engaging with clinical teams to enhance risk adjustment and documentation.

Posted 6/25/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $86,300 - $118,700 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

ICD-10-CM codingrisk adjustment methodologiescoding validationaudit processesdata analysiscontinuous quality improvement

Soft Skills

communication skillsindependent workpriority management

Certifications

RN licenseCertified Professional Coder (CPC)Certified Risk Coder (CRC)Certified Coding Specialist (CCS)