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 performance
- Comprehensive benefits package including medical, dental, and vision coverage, 401(k), and paid time off
- Flexible remote work opportunity with a supportive work environment
- Opportunity to make a significant impact on healthcare quality and compliance
- Engaging work culture focused on health and well-being
What to Expect (Job Responsibilities):
- Perform clinical audit and validation processes to ensure accurate and compliant 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 cases related to fraud, waste, and abuse, documenting findings and follow-up actions
- Collaborate with team members and report findings 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 health industry
- Experience with outpatient CPT/HCPCS codes
- Proficiency in 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
- Previous clinical auditing experience
- Bachelor's degree
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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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