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
- Bonus incentive plan based on company and individual performance
- Competitive benefits including medical, dental, vision, 401(k), and paid time off
- Opportunity for career advancement within a leading healthcare organization
- Work remotely with a flexible schedule
- Supportive work environment focused on employee well-being
What to Expect (Job Responsibilities):
- Validate and interpret medical documentation to ensure accurate coding and compliance
- Conduct reviews of provider codes and billing, focusing on laboratory services
- Involve in auditing claims for genetics, drug testing, and infection agent testing
- Review cases related to fraud, waste, and abuse, documenting and following up on results
- Collaborate with healthcare teams to support optimal reimbursement processes
What is Required (Qualifications):
- Active RN license
- Minimum of 2+ years of clinical experience
- 3+ years' experience in the healthcare industry
- Experience with outpatient CPT/HCPCS codes
- Proficient in reviewing medical records
How to Stand Out (Preferred Qualifications):
- Certified Professional Coder (CPC)
- Familiarity with lab or genetic testing processes
- Experience in fraud, waste, and abuse investigations
- Background in clinical auditing
- 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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