Humana Looking For Nurse Auditor Review at Charleston, WV Full Time

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.

Responsibilities

The 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 Qualifications

• Active Registered Nurse (RN) license

• CPT coding experience or certification

• MS Office proficiency

• 18 months of medical record or coding auditing experience

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

• Ability to work independently and manage work load

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

• Experience applying CMS manual, NCCI edits, LCD / NCD documentation to audits

WORK 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 Qualifications

• Bachelor’s Degree in relevant field preferred

• Prospective payment methodologies, auditing experience

• Clinical documentation improvement knowledge

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 25×10 (25mbs download x 10mbs upload) for optimal performance of is required

Scheduled Weekly Hours

40