[Hiring] Nurse Medical Coder @Humana

Role Description

The Senior Market Consultation / Partnership Professional (Nurse Medical Coder) supports Clinical Support Team (CST) initiatives by promoting accurate, compliant, and complete documentation and coding practices that enhance the quality and measurement of programs across risk adjustment. Work assignments involve moderately complex to complex issues where analysis of clinical documentation, coding accuracy, and risk adjustment data requires evaluation of multiple variable factors.

• 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

Qualifications

• 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

Requirements

• Experience in Medicare Advantage risk adjustment (CMS-HCC models)
• Background in provider education, clinical documentation improvement (CDI), or market-based consulting
• Experience working in a matrixed environment supporting cross-functional teams
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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
• Many other opportunities

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.

$86,300 - $118,700 per year

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

Application Deadline

07-05-2026