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, and vision coverage
- Opportunities for personal wellness and smart healthcare decisions for you and your family
- Remote work flexibility with occasional travel for training or meetings
- Supportive work environment promoting whole-person well-being
What to Expect (Job Responsibilities):
- Validate and interpret medical documentation to ensure accurate coding
- Conduct reviews of provider codes and billing with a focus on laboratory services
- Perform medical audits for genetics, drug testing, and infection agent testing claims
- Review cases related to fraud, waste, and abuse, documenting and following up on results
- Collaborate with team members to enhance payment integrity processes
What is Required (Qualifications):
- Active RN license
- Minimum of 2+ years clinical experience
- At least 3+ years of experience in the health industry
- Experience with outpatient CPT/HCPCS codes
- Proficiency in the review of medical records
How to Stand Out (Preferred Qualifications):
- Certified Professional Coder (CPC) designation
- Familiarity with lab or genetic testing
- Experience in fraud, waste, and abuse investigations
- Clinical auditing experience
- Bachelor's degree in a related field
#HealthcareServices #NurseAuditor #RemoteWork #CompetitivePay #CareerGrowthAbout 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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