Nurse Auditor Review

DescriptionThe 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.ResponsibilitiesThe Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding. Applies clinical and coding experience to conduct reviews of provider codes and billing.Makes decisions of clinical appropriateness based on submitted provider information. 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.Required QualificationsActive Registered Nurse (RN) licenseCPT coding experience or certificationMS Office proficiency18 months of medical record or coding auditing experienceDemonstrated ability to exercise solid judgment and discretion in handling and disseminating informationAbility to work independently and manage work loadExcellent writing, editing, interpersonal, planning, teamwork, and communications skillsExperience applying CMS manual, NCCI edits, LCD / NCD documentation to auditsWORK HOURS : Monday-Friday, 5 days week, 8 hours per day, work must be performed/scheduled between 6AM-6PM EST.This role will be performed 100% remotely/work at home.Preferred QualificationsBachelor's Degree in relevant field preferredProspective payment methodologies, auditing experienceClinical documentation improvement knowledgeWork at Home/Remote RequirementsMust ensure designated work area is free from distractions during work hours and virtual meetingsMust provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 25x10 (25mbs download x 10mbs upload) for optimal performance of is requiredScheduled Weekly Hours40Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our Apply tot his job