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 package including medical, dental, vision, 401(k), and paid time off
- Opportunity for career advancement and professional growth within a leading healthcare organization
- Flexible remote work arrangement with occasional travel for training or meetings
- Supportive work environment focused on employee well-being and development
What to Expect (Job Responsibilities):
- Perform clinical audit and validation processes to ensure medical record documentation and coding accuracy
- Validate and interpret medical documentation to ensure appropriate coding capture
- Conduct reviews of provider codes and billing, focusing on laboratory services
- Review cases related to fraud, waste, and abuse, ensuring proper documentation and follow-up
- Collaborate with team members to maintain compliance with regulatory standards
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
- Experience 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
- Clinical auditing experience
- Bachelor's degree
#HealthcareServices #NurseAuditor #RemoteWork #CareerGrowth #HealthcareCareersAbout 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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