Nurse Auditor - Humana : Job Details

**Become a part of our caring community and help us put health first**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, extensive research, and independent determination of the appropriate courses of action.The SIU clinical review team is seeking a Nurse Auditor 2. This role will support Humana's Government Business. 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 will apply clinical and coding experience to conduct reviews of medical claims. The nurse will conduct research to validate medical necessity of claims. The nurse will understand 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.The ideal candidate will be an avid learner with excellent research skills. In addition, the nurse will be able to communicate audit findings confidently to other Humana associates.The Nurse Auditor 2 will either need a government clearance or be willing to obtain clearance upon hire..**Use your skills to make an impact****WORK STYLE:** Work at home/remote. There might be very, very occasional need for travel (