Nurse Auditor 2-Remote/Virtual in US

Profile

Job Information

Humana

Nurse Auditor 2-Remote/Virtual in US

in

Wilmington

Delaware

Description

The Nurse Auditor 2 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. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Where you Come In

Humana is looking for a Nurse Auditor 2 Professional who is experienced in within the fraud waste and abuse arena. Do you love auditing and investigating clinical/coding information, researching medical materials and sources in order to validate findings and facts? Do you take the initiative to go above and beyond the obvious to find the truth? Do you take great pride in compiling and presenting your audit findings? If you answered YES to one or more of the above you should strongly consider Humana's Nurse Auditor 2 Professional opportunity.

Performs in a production based environment of clinical audit/validation process to ensure that medical record documentation and diagnosis coding is accurate to support billed clinical diagnosis

Applies clinical and coding experience to conduct validation of billed diagnosis

Applies clinical/coding knowledge to identify unusual billing and coding patterns

Coordinates with the fraud abuse investigative team with case audits to assemble clinical/coding findings

Prepares complex case investigative audit findings reports to present to the investigative team

Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance when needed

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications - What it takes to Succeed

Minimum of an Associate's Degree

Must hold an active RN license

Must hold at least one active coding credential (CPC, CCS, CRC, RHIA or RHIT)

Healthcare experience within a fraud investigations unit

Minimum of 1 year of experience with risk adjustment medical coding as well as solid knowledge of healthcare payment methodologies

Proficient in building Power Point presentations, Excel and Word

Demonstrated ability to exercise solid judgement and discretion in handling and disseminating information

Inquisitive nature with ability to analyze data

Excellent writing, presentation, interpersonal, planning, teamwork and communication skills

We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law.

Preferred Qualifications

Graduate degree and/or certifications (BSN, MSN, Clinical Certifications, CFE, AHFI)

Experience in a corporate environment and understanding of business operations

Additional Information - How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Company info

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