Nurse Auditor

Description

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.

Responsibilities

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.

               

WORK STYLE: This role is Remote/Work at Home. There might be very rare travel required for meetings, trainings, and/or conferences.

WORK HOURS: Typical hours are between 6AM-6PM in the employee's home time zone. 8 hours/day, 5 days/week, Monday-Friday, as business needs dictate. Occasional overtime might be offered, but is not mandatory.

Required Qualifications

• Active unrestricted Registered Nurse (RN) license

• 18 months or more of clinical/patient care experience

• Experience working with CPT/HCPCS codes

• Excellent research and verbal communication skills

• MS Office proficiency

• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information

• 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

• Auditing or medical record review experience

• CPC or other coding certification

• Demonstrated ability to lead process/project initiatives

• Bachelor's degree

• Familiarity with CMS policies and/or Humana Medical Coverage Policies

• Behavioral health office experience

• Home health office experience

Additional Information

Work at Home Requirements

•    WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
•    A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.  
•    Satellite and Wireless Internet service is NOT allowed for this role.
•    A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Additional Information - How We Value You  

•    Benefits starting day 1 of employment 

•    Competitive 401k match  

•    Generous Paid Time Off accrual  

•    Tuition Reimbursement 

•    Parental Leave 

•    Go365 perks for well-being 

Interview Format 

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#ThriveTogether #WorkAtHome
 

Scheduled Weekly Hours

40