Nurse Auditor 2 - Remote - #494854

Humana Inc.

Date: 10/14/2021 11:30 AM

City: Metairie, Louisiana

Contract type: Full Time

Work schedule: Full Day


The RN Clinical team is looking for a dynamic Registered Nurse to join the team working remote anywhere in the US or in Louisville, KY! We are looking for someone who has a great attention to detail, good understanding of Medicare guidelines, enjoys researching and reviewing medical record documentation for incorrect billing and coding. The ideal candidate will be someone who applies clinical and coding experience in their decisions, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed; following established guidelines and procedures. This position consults with and collaborates with interdepartmental business partners.


Humana is seeking an individual to focus on preventing unnecessary payments to providers and recovering overpayments when they happen.

The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant billing discrepancies. Identifies the root cause analysis of audit findings and submits recommendations for query improvement. Performs routine and special audits of par and non-par provider claims to determine payment accuracy. Makes recommendations regarding the accuracy of claim payments and process improvements. Reviews and audits claims that match the query. Applies clinical and coding experience to conduct reviews of provider codes 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 and is adaptable to change and working in fast paced environments.

Required Qualifications

  • Associate's Degree
  • Active Registered Nurse (RN) license in state of residence
  • Minimum 2 years of Medical billing claims review
  • MS Office proficiency
  • Core business hours are Monday-Friday (8:00am – 4:30pm EST) with possible flexibility. Possible overtime based on business need. Core business hours align to Eastern Standard Time (EST)
  • Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
  • Ability to work independently and manage work load
  • 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
  • We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve
  • If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work

Work-At-Home Requirements

  • Must ensure designated work area is free from distractions during work hours and virtual meetings
  • Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

  • Bachelor's Degree
  • CPC or any other coding relevant coding certification
  • Prospective payment methodologies, auditing experience
  • CPT procedural code experience

Additional information

  • Optional travel to Louisville, KY for training/meetings for a maximum of 2-3 times per year

Scheduled Weekly Hours


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