Medical Coding Auditor

Humana • Washington, DC

1d • Remote

About The Position

The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and coding for services rendered is complete, compliant, and accurate to support optimal reimbursement. You will report to the Supervisor, Payment Integrity. As the Nurse Auditor 2 you will Validate and interpret medical documentation to ensure capture of all relevant coding. Apply clinical and coding experience to conduct reviews of provider codes and billing Focus on laboratory services and involve medical auditing of genetics, drug testing and infection agent testing claims that require interpretation and independent determination of the appropriate courses of action. Reviews involve the review of Fraud Waste and abuse case determinations and require documentation and follow up regarding the result of these cases. Use your skills to make an impact

Requirements

• Active RN license
• Experience with outpatient CPT/HCPCS codes
• Experience with review of medical records
• 2+ years clinical experience
• 3+ years' experience in the health industry

Nice To Haves

• Certified Professional Coder (CPC)
• Familiar with lab or genetic testing
• Fraud, Waste, and Abuse Investigative experience.
• Clinical auditing experience
• Bachelor's degree
• Familiarity with CMS and Humana regulatory policies
• Knowledge of general lab billing

Responsibilities

• Validate and interpret medical documentation to ensure capture of all relevant coding.
• Apply clinical and coding experience to conduct reviews of provider codes and billing
• Focus on laboratory services and involve medical auditing of genetics, drug testing and infection agent testing claims that require interpretation and independent determination of the appropriate courses of action.
• Reviews involve the review of Fraud Waste and abuse case determinations and require documentation and follow up regarding the result of these cases.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees