Nurse Auditor 2

Humana - Boston, MA

Full-time - Mid Level

Remote - Boston, MA

Insurance Carriers and Related Activities

About the position

The Nurse Auditor 2 plays a crucial role in ensuring the accuracy and compliance of medical record documentation and diagnosis coding. This position involves performing clinical audits and validations to support optimal reimbursement for services rendered. The role requires independent decision-making and a strong understanding of clinical and coding practices, making it essential for maintaining high standards in healthcare documentation.

Responsibilities

• Perform clinical audit and validation processes for medical record documentation.
• Ensure compliance and accuracy of diagnosis coding for services rendered.
• Conduct reviews of medical claims using clinical and coding experience.
• Make independent decisions regarding work methods in ambiguous situations.
• Communicate audit findings confidently to other associates.

Requirements

• Registered Nurse (RN) license required.
• Experience in clinical auditing and coding.
• Strong research skills and attention to detail.
• Ability to work independently with minimal direction.

Nice-to-haves

• Experience with medical claims processing.
• Familiarity with healthcare reimbursement processes.

Benefits

• Health insurance coverage
• Flexible scheduling options
• Professional development opportunities