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Registered Nurse

Humana

This is a Contract position in Chicago, IL posted May 14, 2019.

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 The Nurse Auditor 2 validates and interprets medical documentation to ensure capture of all relevant coding.

Identifies members with high risk CMS Hierarchical Condition Categories (HCC) and refers cases for annual follow-up care by disease management, case management, and primary care providers as appropriate for assessment/intervention.

Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management.

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.

Required Qualifications
• Minimum of an Associate’s Degree
• Current US RN License
• Coding experience
• Minimum of 2 years of clinical experience within Home Health field
• Previous experience in medical record reviews/auditing or extensive experience in Home Health
• Comprehensive understanding of all related Home Health guidelines including coding, billing and CMS regulations
• Able to apply analytical and critical thinking to Home Health record reviews
• Working knowledge Microsoft Word, Excel and PowerPoint
• High level of emotional intelligence
• Ability to work independently and manage work load
• Comfortable working in a production based work environment Preferred Qualifications
• 3 years of auditing experience in Home Health
• At least one of the following Certifications: Home Health
– certified OASIS coder
– HCS-O, HCS-D, COS-C Additional InformationInterview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability.

Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview.

In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question.

You should anticipate this interview to take about 15 to 30 minutes.

Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours 40 About Us Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.

View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruithumana.com for assistance.

Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process.

If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruithumana.com to validate the request.