Humana
Nurse Auditor
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Job Description
- Req#: R-405187
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $107,800 per year
- Eligible for a bonus incentive plan based on company and individual performance
- Comprehensive benefits including medical, dental, vision, 401(k), paid time off, and life insurance
- Opportunity to work remotely with flexible hours
- Supportive work environment focused on personal wellness and smart healthcare decisions
- Chance to make a meaningful impact on the quality of care for various communities
What to Expect (Job Responsibilities):
- Perform clinical audits and validation processes to ensure accurate medical record documentation and coding
- Validate and interpret medical documentation for relevant coding capture
- Conduct reviews of provider codes and billing, focusing on laboratory services, including genetics and drug testing
- Review fraud, waste, and abuse cases, documenting findings and following up on outcomes
- Collaborate with team members and report to the Supervisor, Payment Integrity
What is Required (Qualifications):
- Active RN license
- Minimum of 2 years of clinical experience
- At least 3 years of experience in the healthcare industry
- Proficient in outpatient CPT/HCPCS coding and medical record review
- Strong analytical skills and attention to detail
How to Stand Out (Preferred Qualifications):
- Certified Professional Coder (CPC)
- Familiarity with lab or genetic testing processes
- Experience in fraud, waste, and abuse investigations
- Prior clinical auditing experience
- Bachelor's degree in a relevant field
#HealthcareServices #RemoteWork #NurseAuditor #ClinicalAuditing #CareerOpportunity
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."About the company
Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs
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