Home Health Quality Assurance Auditor at Humana

Miramar, Florida, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Applicable State licensure in field of study: Registered Nurse (RN), Licensed Masters Clinical Social Worker (LCSW), Licensed Masters Social Worker (LMSW-ACP), Licensed Professional Counselor (LPC), or other applicable professional license
Understands own work area professional concepts/standards, regulations, strategies, and operating standards
Ability to make decisions regarding own work approach/priorities and follow direction
Work managed and guided by precedent and/or documented procedures/regulations/professional standards with some interpretation

Responsibilities

Consult and collaborate with clinicians to ensure high accountability of compliance and quality
Support and implement programs to establish high quality standards in clinical products and services
Support, develop, and operationalize methods to drive program and service consistency
Provide and support training and process management as needed
Review Start of Care (SOC), Recertification, and Discharge documentation for completeness and accuracy, including coding, medication reconciliation, and plan of care alignment
Ensure all records meet federal (e.g., CMS regulations, Medicare Conditions of Participation), state, and payer-specific standards to reduce audit risk and financial exposure
Conduct timely QA reviews to reduce delays in billing and improve key performance indicators such as days to completion and turnaround time
Support clinicians by identifying documentation gaps early, enabling faster corrections and submission
Ensure documentation workflows align with Kinnser EMR system capabilities and staff follow new protocols during transition
Monitor QA dashboard metrics and provide actionable feedback to improve staff performance
Identify trends in documentation errors and collaborate with leadership to develop targeted training and job aids
Support continuous quality improvement and enhance patient safety through proactive approaches

Skills

OASIS

CMS regulations

Medicare Conditions of Participation

Clinical Documentation

Coding

Medication Reconciliation

Plan of Care

QA Auditing

Kinnser EMR

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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