Nurse Auditor 2

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess an active Registered Nurse (RN) license and have a minimum of 2 consecutive years of acute inpatient hospital care experience in a critical, intensive care setting within the last 5 years, or a minimum of 2 years of DRG inpatient auditing experience. A strong understanding of complex medical diagnoses and advanced proficiency in MS Office are essential, along with excellent writing, editing, interpersonal, planning, teamwork, and communication skills. The ability to exercise sound judgment and work independently is also required. A Bachelor's degree and inpatient coding certifications are preferred.

Responsibilities

The Nurse Auditor 2 performs clinical audit and validation processes to ensure medical record documentation and diagnosis coding are complete, compliant, and accurate for optimal reimbursement. This role involves validating and interpreting medical documentation to capture all relevant coding, conducting clinical validation reviews of inpatient medical records, and validating billed diagnoses. The position requires interpreting department, segment, and organizational strategies and making independent decisions regarding work methods with minimal direction.

Skills

Clinical Audit

Medical Documentation

Diagnosis Coding

Reimbursement

DRG Auditing

Registered Nurse (RN)

Acute Inpatient Hospital Care

Critical Care

Intensive Care

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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