Nurse Auditor 2

Position Overview

Become a part of our caring community and help us put health first. The Nurse Auditor 2 will perform acute inpatient Short Stay Reviews/clinical audits considering complex medical factors and MCG, to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Nurse Auditor 2 is a work from home position who will perform Short Stay Reviews/clinical audits to ensure that medical record documentation and diagnosis coding/DRG for services rendered is complete, compliant and accurate to support optimal reimbursement. Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. Applies clinical experience to conduct short stay reviews of provider services and 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. Use your skills to make an impact.

Work Style & Hours

• WORK STYLE: Remote/Work at Home. Occasional travel to Humana's offices for training or meetings may be required.
• WORK HOURS: Typical business hours are Monday-Friday on 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.

Requirements

• Required Qualifications:
  • Active Registered Nurse (RN) license or Licensed Practical Nurse/Licensed Vocational Nurse (LPN or LVN), in your state of residence.
  • Minimum of 5 years acute inpatient bedside and claims auditing experience.
  • Minimum of 3 years' experience utilizing MCG guidelines.
  • Demonstrated ability to lead process/project initiative.
  • MS Office proficiency.
  • Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information.
  • Demonstrated ability to consider complex medical factors.
  • Ability to work independently and manage workload.
  • 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.
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Preferred Qualifications:
  • Associate or Bachelor’s Degree.
  • Inpatient nursing experience, ideally including discharge planning, hospital case management background.
  • Prospective payment methodologies, auditing experience.
  • Clinical documentation improvement (CDI) knowledge.

Work at Home Requirements

• Internet: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.
• Internet Expense Reimbursement: Associates 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.
• Telephone Equipment: Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work Environment: Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire) allows us to quickly connect and gain valuable information.