Beckley, WV, United States
Healthcare, Nursing, Audit
Apr 27, 2021
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.
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, or CRC)
Healthcare experience within a fraud investigations unit
Minimum of 1 years of production clinical/coding auditing role
Minimum of 2 years 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
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
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
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview 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.
Scheduled Weekly Hours
Website : http://www.humana.com