Nurse Auditor 2

Profile

Description

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.

Responsibilities

This position will focus on Medicare/Medicaid/Commercial reviews for the SIU Non Lab team.

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.

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.

Required Qualifications

Active RN license

2 years of clinical experience

Experience in Home Health

Knowledge and familiarity of CPT Codes

Experience using CMS and Humana Medical Coverage Policies

MS Office proficiency

Ability to work independently and manage work load

Excellent writing, editing, interpersonal, planning, teamwork, and communications skills

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Bachelor's Degree

CPC Certification

Auditing experience

Medical record review experience

CPT/HCPCS procedural code experience

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com