San Juan, PR, United States
Work At Home, Healthcare, Nursing, Bilingual
Sep 03, 2021
The Nurse Auditor 2 performs clinical audit/validation processes 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.
This position will focus on Medicare/Medicaid/Commercial reviews for the SIU Non Lab team.
Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement.
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.
Fully Bilingual English/Spanish. Must be able to speak, read and write in both languages without limitations or assistance. If selected for the position, you will be required to take a Language Proficiency Assessment in English/Spanish. See Additional Information on testing
Active and Valid RN license in PR
Active and Valid RN license in the US
2 years of clinical experience (e.g. Review)
Knowledge and familiarity of CPT Codes
Experience using CMS and Humana Medical Coverage Policies
MS Office proficiency
Ability to work independently and manage work load
Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Work At Home requirements: Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Medical record review experience
CPT/HCPCS procedural code experience
Schedule : Eight hours shifts. Monday to Friday either 7 am to 4 pm OR from 8 am to 5 pm. Associate can have 30 min or 1 hr. lunch.
Training: V irtually. Typical training is 2 weeks with an auditor from the leader team, then training will continue for 4-6 weeks as associate learn new cases/reviews
Work Location (Address): Work at Home from Puerto Rico ONLY.
% Travel: none
Language Proficiency Testing (English/Spanish) : Any Humana associate who speaks with a member in a language other than Spanish and/or English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
Scheduled Weekly Hours
Website : http://www.humana.com