Hybrid Nurse Auditor – Level 2

at Humana

• Job title: Nurse Auditor – Level 2
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $78,400 - $107,800 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, United States

About the role

• Nurse Auditor 2 responsible for clinical audits and validating billing accuracy for Humana. Ensuring compliance with medical record documentation and optimizing reimbursement processes.

Responsibilities

• Performs clinical audit/validation processes to ensure that medical record documentation and billing for services rendered is complete, compliant and accurate to support optimal reimbursement
• Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action
• Validates and interprets medical record documentation to ensure billing for services is complete, accurate and follows all necessary guidelines
• Applies clinical experience when conducting chart reviews of hospital and facility billing
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
• Follows established guidelines/procedures

Requirements

• Active Registered Nurse (RN) license
• Minimum of 3+ years nursing experience
• Able to apply analytical and critical thinking skills to reviews
• MS Office proficiency
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
• Ability to work independently, manage workload, and work in a production-based environment
• 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
• Comfortable working in an ever-changing environment

Benefits

• 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