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
- Competitive benefits including medical, dental, and vision coverage, 401(k) retirement plan, and paid time off
- Work remotely with the flexibility of a home office setup
- Opportunity to make a significant impact on healthcare quality and reimbursement processes
- Supportive environment that emphasizes whole-person well-being for employees
What to Expect (Job Responsibilities):
- Perform clinical audits and validations to ensure accurate medical record documentation and coding
- Review provider codes and billing with a focus on laboratory services, including genetics and drug testing
- Conduct investigations into fraud, waste, and abuse cases, ensuring thorough documentation and follow-up
- Utilize clinical and coding knowledge to interpret medical documentation for optimal reimbursement
- Collaborate with the Payment Integrity Supervisor to enhance audit processes
What is Required (Qualifications):
- Active RN license
- Minimum of 2 years of clinical experience
- At least 3 years of experience in the healthcare industry
- Experience with outpatient CPT/HCPCS codes and medical record reviews
- Strong understanding of clinical auditing processes
How to Stand Out (Preferred Qualifications):
- Certified Professional Coder (CPC) designation
- Familiarity with lab or genetic testing procedures
- Previous experience in fraud, waste, and abuse investigations
- Clinical auditing experience
- Bachelor’s degree in a related field
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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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