Menu

Nurse Auditor

at Humana in Chicago, Illinois, United States

Job Description

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

This position will focus on Medicare/Medicaid/Commercial reviews for the SIU Non Lab team.

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.

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.

WORK STYLE: This role is Remote/Work at Home. There might be very rare travel required for meetings, trainings, and/or conferences.

WORK HOURS: Typical hours are between 6AM-6PM in the employee’s home time zone. 8 hours/day, 5 days/week, Monday-Friday, as business needs dictate. Occasional overtime might be offered, but is not mandatory.

Required Qualifications

+ Active unrestricted Registered Nurse (RN) license

+ 18 months or more of clinical/patient care experience

+ Experience working with CPT/HCPCS codes

+ Excellent research and verbal communication skills

+ MS Office proficiency

+ Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information

+ Ability to work independently and manage workload

+ Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession

+ Excellent writing, editing, interpersonal, planning, teamwork, and communications skills

+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

+ Auditing or medical record review experience

+ CPC or other coding certification

+ Demonstrated ability to lead process/project initiatives

+ Bachelor’s degree

+ Familiarity with CMS polic

Copy Link

Job Posting: JC241014760

Posted On: May 27, 2023

Updated On: May 29, 2023

Please Wait ...