Nurse Auditor

About the role

The Nurse Auditor 2 will perform Readmission or Short Stay clinical audits to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. You will report to the Manager, Nurse Audit / Review.

Responsibilities

• Validate and interpret medical documentation to ensure capture of all relevant admission types
• Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management
• Apply clinical experience to conduct reviews of provider services and billing

Requirements

• Active Registered Nurse (RN) license, in your state of residence
• 3 or more years of acute or critical care inpatient bedside nursing experience
• 1 or more years of claim review or auditing experience

Preferred Qualifications

• Associate or Bachelor's Degree
• Milliman Care Guidelines
• Clinical documentation improvement (CDI) knowledge
• Case Management or Discharge planning in an acute care setting

Skills

Use your skills to make an impact

Benefits

See details under "About Us" section

Pay

$78,400 - $107,800 per year

Schedule

Typical business hours are Monday-Friday 6:00 am to 6:00 pm EST (Eastern Standard Time), regardless of the associate's home time zone. 8 hours/day, 5 days/week. Some flexibility might be possible, depending on business needs.

Additional Information

Work Style: Remote/Work at Home. While this is a remote position, Humana may require occasional travel to its offices for training or meetings.