at Humana in Dover, Delaware, United States
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 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. Able to identify overpayments made in error to providers.
+ Current US RN License with 1+ year Coding experience
+ 3 years of clinical experience within Home Health field
+ Previous experience in medical record reviews/auditing or extensive experience in Home Health
+ Comprehensive understanding of all related Home Health guidelines including coding, billing or CMS regulations.
+ Able to apply analytical and critical thinking to Home Health record reviews
+ Working knowledge Microsoft Word, Excel and PowerPoint
+ High level of emotional intelligence
+ Ability to work independently and manage work load
+ Comfortable working in a production based work environment
+ 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 10×1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
+ At least one of the following Certifications: Home Health- certified OASIS coder- HCS-O, HCS-D, COS-C
+ 3-5 years of auditing experience in Home Health.
+ Certified Professional Coder (CPC)
+ Bachelor’s Degree
+ Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing
+ Schedule: Monday to Friday from 8 am to 5 pm (Flexible). Overtime as per business needs.
+ Training: 3 weeks remotely.
+ Work Location (Address): WAH Nationwide
+ % Travel: 10% Louisville, KY
+ Language Proficiency Testing (English/Spanish): Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
Scheduled Weekly Hours