Nurse Auditor: Home Health Care Clinical Specialist

Humana

4d • Remote

About The Position

Become a part of our caring community and help us put health first 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. The Nurse Auditor 2’s 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. Applies clinical and coding experience to conduct reviews of provider codes and billing. Makes decisions of clinical appropriateness based on submitted provider information. 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. Use your skills to make an impact WORK STYLE: Remote, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Associates are expected to start each day between 6AM and 9AM EST, regardless of their home time zone.

Requirements

• Must have current U.S. RN (Registered Nurse) license, in the state of residence, without any restrictions
• Associate must reside in the continental US
• Minimum of 1 year of clinical experience with the Home Health Care Payment Driven Groupings Model (PDGM) and Pay-per-visit (PPV), including reading and interpreting medical records and claims, as well as experience in dispute resolution and analyzing trends in results
• Certified OASIS specialist-Clinical (COS-C) and/or Home Care specialist- OASIS (HCS-O) certification
• Comprehensive understanding of CMS regulations and knowledge of medical coding and billing
• MS Office proficiency (Word, Excel, Teams, Outlook)
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
• Ability to work independently, make decisions and manage workload
• 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

Nice To Haves

• HCS-D (Home Care Specialist- Diagnostic) certification for ICD-10 coding
• CPT coding experience or certification
• Applied knowledge of Prospective payment methodologies, auditing experience

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our 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
• Education Level: No Education Listed