[Remote] Nurse Auditor 2 at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Associate degree
Active Registered Nurse (RN) license in the state of current residence
Minimum of 2 consecutive years acute inpatient hospital care experience in critical, intensive care setting within the last 5 years (not pediatrics or neonatal) OR minimum of 2 years DRG Inpatient auditing experience
In-depth knowledge and critical understanding of complex medical diagnoses
Advanced knowledge of MS Office (Word, Excel, etc.)
Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
Ability to work independently and manage workload
Customer-service focused and exhibits professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
Minimum download speed of 25 Mbps and upload speed of 10 Mbps internet connection

Responsibilities

Performs clinical audit/validation processes to ensure medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement
Validates and interprets medical documentation to ensure capture of all relevant coding
Applies clinical and coding experience to conduct a clinical validation review of the inpatient medical record to validate billed diagnoses
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

Skills

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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