Nurse Auditor

Humana Inc; Northern (KY); Hybrid; USD 78,000 - 108,000; Full time

Benefits offered by this job

Remote work

Travel for training

Bonus incentive program

Job summary

Humana Inc. is seeking a Nurse Auditor 2 to perform clinical audit and validation of medical records and coding. Remote nationwide role; occasional office visits may be required.

You will interpret documentation to ensure complete, compliant coding and identify high-risk cases for follow-up care. The role requires an active RN license, 2+ years of inpatient care, and strong knowledge of complex diagnoses, with excellent writing and communication skills.

Qualifications

• Active RN license in the state of residence.
• Minimum of 2 consecutive years acute inpatient hospital care experience in the last 5 years.
• Strong knowledge of complex medical diagnoses (e.g., sepsis, MI).
• Advanced writing, editing and interpersonal skills.

Responsibilities

• Perform clinical audit/validation to ensure complete and accurate coding for services rendered.
• Identify high-risk CMS HCC cases and refer for follow-up care as appropriate.
• Conduct root-cause analyses of audit findings and propose changes.
• Apply clinical and coding experience to reviews of provider codes and billing.

Skills

RN license

Inpatient care

Coding knowledge

Clinical documentation

MS Office

Communication

Education

Bachelor's degree preferred

AHIMA/AAPC inpatient coding certification

Tools

MS Office

Word

Excel

Job description

## Nurse AuditorApply: Remote Nationwide: Full time: Posted Today: R-431355# **Become a part of our caring community**The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding. Identifies members with high risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical and coding experience to conduct reviews of provider codes and billing. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.# **Use your skills to make an impact****WORK STYLE:** Remote/Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Associates are expected to start each day between 6AM and 9AM in their home time zone.**Required Qualifications*** Active Registered Nurse (RN) license in the state they reside.* Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (Not pediatrics or neonatal). For example: ICU, CCU, PCU, med-surg/adult units or a minimum of 2 years DRG Inpatient auditing. NOTE: Inpatient experience does **not** refer to any other levels of care such as ER, OR, Pre-op, PACU, L&D, mother-baby, behavioral health, SNF, care manager/discharge manager, LTC, rehab, outpatient or office/clinic visits such as wound care, oncology, radiology, interventional radiology, lab, hospice, or home health.* In depth knowledge and critical understanding of complex medical diagnoses including, but not limited to, Sepsis (including end-organ failure), Pneumonia, Acidosis, Renal Failure, Encephalopathy, CVA, DKA, MI, etc.* Advanced knowledge of MS Office (Word, Excel, etc)* Excellent writing, editing, interpersonal, planning, teamwork, and communications skills* Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information* Ability to work independently and manage workload* Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession**Preferred Qualifications*** Bachelor’s Degree in relevant field preferred* Inpatient coding certification (AHIMA or AAPC – ex: RHIA, RHIT, CCS, CIS, CIC)* Inpatient coding claim experience* Prospective payment methodologies, DRG auditing experience* Clinical documentation improvement knowledge (CDE, CDEI certification)**Additional Information****Work at Home Requirements**• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested• Satellite, cellular and microwave connection can be used only if approved by leadership• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information**Interview Format**As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded vWork at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.**Scheduled Weekly Hours**40**Pay Range**The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$78,400 - $107,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.**Description of Benefits**Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.