Nurse Auditor

** Become a part of our caring community*
* 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.

As the Nurse Auditor 2, you will

+ 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

+ Work from home position

** Use your skills to make an impact*
* ** Required Qualifications*
* + 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

** Additional Information*
* ·  
** Work Style:
** Remote/Work le this is a remote position, Humana may require occasional travel to its offices for training or meetings.

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* Work hours:

** 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.

** Hire Vue*
* As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

** Work at Home*
* To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.

+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Work at Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

** Scheduled Weekly Hours*
* 40

** Pay Range*
* The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

** Description of Benefits*
* Humana, Inc. and its affiliated subsidiaries…