Nurse Auditor 2/RN Coding and Home Health Field exp a MUST Work At Home

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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

The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding. 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. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Able to identify overpayments made in error to providers.

Required Qualifications

Current US RN License with 1 year Coding experience

3 years of clinical experience within Home Health field

Previous experience in medical record reviews/auditing or extensive experience in Home Health

Comprehensive understanding of all related Home Health guidelines including coding, billing or CMS regulations.

Able to apply analytical and critical thinking to Home Health record reviews

Working knowledge Microsoft Word, Excel and PowerPoint

High level of emotional intelligence

Ability to work independently and manage work load

Comfortable working in a production based work environment

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

Preferred Qualifications

At least one of the following Certifications: Home Health- certified OASIS coder- HCS-O, HCS-D, COS-C

3-5 years of auditing experience in Home Health.

Certified Professional Coder (CPC)

Bachelor's Degree

Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing

Additional information

Schedule: Monday to Friday from 8 am to 5 pm (Flexible). Overtime as per business needs.

Training: 3 weeks remotely.

Work Location (Address): WAH Nationwide

% Travel: 10% Louisville, KY

Language Proficiency Testing (English/Spanish): Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.

Scheduled Weekly Hours

40

Company info

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