Senior Nurse Auditor RN - Remote/Work at Home Nationwide

Profile

Description

Humana's recently created Clinical Resource Team is looking to grow the team with a Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly jump to the aid of several teams throughout the organization. The team floats to the work, as assigned, and helps their fellow co-workers with whatever challenges they're facing.

Responsibilities

So do you love working on several different projects? Have you been thinking it is time to advance your career into a senior role? Do you take pride in helping others and being flexible? Do you have great attention to details and a passion for healthcare? Do you have a solid clinical background in acute care? Well, if you answered YES to one or more of the above you should strongly consider the Senior Nurse Auditor opportunity with Humana.

Performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement.

Validates and interprets medical documentation to ensure capture of all relevant coding.

Identifies members with high risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention.

Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management.

Applies clinical and coding experience to conduct reviews of provider codes and billing.

Will be part of a float team that requires flexibility and the ability to work assignments that change frequently, and at times, may work multiple assignments to meet the organization's needs.

What you need for success! - Required Qualifications

Licensed Registered Nurse, RN, in the state of residence without any restrictions.

5 years of diverse clinical experience, will consider less experience for those with current coding certifications with AAPC or AHIMA.

Prior medical coding experience and/or enrolled in coding course.

Must be able to obtain at least one medical coding certification with AAPC or AHIMA within 1 year of starting this role.

Work at Home Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

What you need to be considered a Superstar! - Preferred Qualifications

BSN or Bachelor's degree in a related field.

Currently hold at least one medical coding certification with AAPC or AHIMA.

Health Plan experience working with large carriers.

Previous Medicare/Medicaid experience a plus.

Experience working with MCG or Interqual guidelines.

Additional Information

Once the health concerns effecting our country calms down this role may be required to travel 2-4 times a year for training and team building events.

The operating hours for the department is Monday - Friday 6 am - 6 pm and individuals are able to work flex schedules as long as the 40 hours per week are met.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com