at Humana in Rogers, Arkansas, United States
Job Description
Description
The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and CPT coding and billing 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
The Nurse Auditor validates and interprets medical documentation to ensure capture of all relevant billing. You will apply clinical and coding experience to conduct reviews of provider codes and billing. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. The Nurse Auditor follows all established guidelines/procedures. Humana is seeking an individual to focus on preventing unnecessary payments to providers and recovering overpayments when they happen.
+ Reviews claims submitted to ensure correct guidelines have been followed
+ Utilizes clinical expertise when necessary when reviewing Itemized Bills
+ Perform routine and special audits of par provider claims to determine payment accuracy
+ Make recommendations regarding the accuracy of claim payments and process improvements
+ Utilize Excel for reporting when necessary
+ Review and audit claims that match the query
Required Qualifications
+ Current RN license in state of residence
+ Associate’s degree
+ Minimum 2 years of clinical experience
+ Ability to apply analytical and critical thinking to record reviews
+ If located outside the city of Louisville, KY — may require travel to Louisville for training for a maximum of 3-4 days annually
+ Working knowledge of Microsoft Excel
+ Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
+ Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
+ Must ensure designated work area is free from distractions during work hours and virtual meetings
+ Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10×1 (10mbs download x 1mbs upload) for optimal performance of is required
Preferred Qualifications
+ Bachelor’s Degree
+ Coding certification (CPC preferred)
+ Previous background in auditing such as experience in medical record review
+ Comprehensive understanding of all related guidelines related to coding and/or billing
Additional information
+ Schedule : Monday to Friday from 8 am – 5 pm, Overtime when needed
+ Training: 2-4 weeks mandatory virtual training
Scheduled Weekly Hours
40
