Senior Quality Assurance Clinical Professional - Work at home nationwide

Profile

Description

The Senior Quality Assurance, Clinical Professional requires being both a nurse/RN and a certified Coder nurse as this position will be cross trained to review DRG (Diagnosis Related Group) audits as well as HCC (Hierarchical Condition Categories) audits.

This position consults and collaborates with clinicians to ensure high accountability of compliance and quality and will work assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The hours are Mon-Fri with flexible scheduling between the hours of 6am- 6pm.

Required Qualifications:

Registered Nurse with active license in state of residence

Certification from AAPC or AHIMA (CPC, CCS, CIC, CRC, CCDS, CDIP, CPMA or equivalent)

2 years of inpatient and outpatient medical record review and auditing experience.

Demonstrated ability to apply critical review judgment to make clinical determinations

Knowledge of inpatient and outpatient coding conventions and standards

Working knowledge Microsoft Word, Excel and PowerPoint

High level of emotional intelligence and strong communication skills

Ability to work independently and manage work load

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications:

Minimum of 3-5 years of general nursing experience (Med/Surg, ED, ICU preferred)

Extensive regulatory coding (ICD-10-CM, MS-DRGs, Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes) and associated reimbursement knowledge

Experience in HCC (Hierarchical Condition Categories) coding documentation guidelines and compliance rules

Must demonstrate working knowledge of clinical indicators, risk factors and treatment protocols used for clinical validation and appropriate code assignments

Solid understanding of anatomy and physiology, diagnostic procedures, and surgical operations.

Experience with multiple EHR systems and Quality Assurance reviews

Experienced with effective collaborative training to support and improve clinical nurse auditor's quality

Scheduled Weekly Hours

40

Company info

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