Senior Nurse Auditor RN

Profile

Description

Humana's recently created Clinical Resource Team is looking to grow the team with a couple Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly jump to the aid of several teams throughout the organization. The team floats to the work, as assigned, and helps their fellow co-workers with whatever challenges they're facing.

So do you love working on several different projects? Do you take pride in helping others and being flexible? Do you have great attention to details and a passion for healthcare? Do you have a solid clinical background in acute care? Well, if you answered YES to one or more of the above you should strongly consider the Senior Nurse Auditor opportunity with Humana.

So do you love working on several different projects? Do you take pride in helping others and being flexible? Do you have great attention to details and a passion for healthcare? Do you have a solid clinical background in acute care? Well, if you answered YES to one or more of the above you should strongly consider the Senior Nurse Auditor opportunity with Humana.

Responsibilities


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.
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.
Will be part of a float team that requires flexibility and the ability to work assignments that change frequently, and at times, may work multiple assignments to meet the organization's needs.


What you need for success! - Required Qualifications


Licensed Registered Nurse, RN, in the state of residence without any restrictions.
5 years diverse clinical experience to include acute care, inpatient, and/or long-term care.
Currently hold at least one medical coding certification with AAPC or AHIMA.
3 years auditing experience including medical record review.


Work at Home Requirements


Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.


What you need to be considered a Superstar! - Preferred Qualifications


BSN or Bachelor's degree in a related field.
Health Plan experience working with large carriers.
Previous Medicare/Medicaid experience a plus.
Experience working with MCG or Interqual guidelines.


Additional Information


Once the health concerns effecting our country calms down this role may be required to travel 2-4 times a year for training and team building events.
The operating hours for the department is Monday - Friday 6 am - 6 pm and individuals are able to work flex schedules as long as the 40 hours per week are met.


Scheduled Weekly Hours

40

Company info

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