[Remote] Nurse Auditor 2 at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

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
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps (wireless, wired cable or DSL connection suggested; satellite, cellular and microwave only if approved)

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
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
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

Key technologies and capabilities for this role

Registered Nurse (RN) licenseclinical auditchart reviewmedical record documentationbilling complianceanalytical thinkingcritical thinkingMS Officewritingediting

Questions & Answers

Common questions about this position

Is this a remote position?

Yes, this is a remote work-at-home position, though occasional travel to Humana's offices for training or meetings may be required.

What are the required qualifications for the Nurse Auditor 2 role?

Candidates must have an active Registered Nurse (RN) license, a minimum of 3+ years nursing experience, ability to apply analytical and critical thinking skills, MS Office proficiency, and strong judgment, communication, and teamwork skills.

What are the typical work hours for this position?

Typical business hours are Monday-Friday, 5 days/week, 8 hours/day, with some flexibility possible depending on business needs; associates work in their own time zone.

What preferred qualifications will make me stand out?

Strongly preferred are previous auditing, Nurse Coder background, CPT procedural code experience or certified coder (CPC), nursing experience in Acute care, OR, Coding, or Quality, clinical documentation improvement (CDI) knowledge, and a Bachelor's Degree in a relevant field.

What are the work at home technical requirements?

A minimum download speed of 25 Mbps and upload speed of 10 Mbps is recommended, with wired cable or DSL suggested; satellite, cellular, or microwave connections require leadership approval.

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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