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
- Competitive benefits including medical, dental, vision, 401(k), paid time off, and life insurance
- Opportunity for career advancement and professional growth within the organization
- Flexible work-from-home arrangement with occasional travel for training or meetings
- Supportive work environment focused on employee well-being and personal wellness
What to Expect (Job Responsibilities):
- Perform clinical audit and validation processes to ensure accuracy of 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
- Review cases of fraud, waste, and abuse, ensuring proper documentation and follow-up
- Collaborate with the Supervisor, Payment Integrity, to enhance compliance and reimbursement processes
What is Required (Qualifications):
- Active RN license
- Minimum of 2 years clinical experience
- Minimum of 3 years' experience in the healthcare industry
- Experience with outpatient CPT/HCPCS codes
- Experience reviewing medical records
How to Stand Out (Preferred Qualifications):
- Certified Professional Coder (CPC)
- Familiarity with lab or genetic testing
- Experience in fraud, waste, and abuse investigations
- Clinical auditing experience
- Bachelor's degree in a relevant 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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