Humana
Nurse Auditor
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Job Description
- Req#: R-405187
Employer Industry: Healthcare Insurance 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 package including medical, dental, vision, and 401(k) retirement savings plan
- Opportunities for personal wellness and smart healthcare decisions for you and your family
- Flexible remote work environment with occasional travel for training or meetings
- Supportive and inclusive company culture focused on employee well-being
What to Expect (Job Responsibilities):
- Perform clinical audit and validation processes to ensure medical record documentation and coding are complete and accurate
- Validate and interpret medical documentation to capture all relevant coding
- Conduct reviews of provider codes and billing, focusing on laboratory services including genetics and drug testing
- Review cases of fraud, waste, and abuse, documenting and following up on outcomes
- Collaborate with the Supervisor, Payment Integrity to enhance audit processes
What is Required (Qualifications):
- Active RN license
- Minimum of 2+ years clinical experience
- At least 3+ years of experience in the healthcare industry
- Experience with outpatient CPT/HCPCS codes and review of medical records
- Strong understanding of clinical auditing processes
How to Stand Out (Preferred Qualifications):
- Certified Professional Coder (CPC) certification
- Familiarity with laboratory or genetic testing
- Experience in fraud, waste, and abuse investigations
- Clinical auditing experience
- Bachelor's degree in a related field
#HealthcareInsurance #NurseAuditor #RemoteWork #CareerGrowth #CompetitiveBenefitsAbout 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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