Humana Home Health Clinical Auditor - RN in Cincinnati, Ohio

Role : Home Health Clinical Auditor - RN
Assignment: Provider Payment Integrity/Clinical Audit Location: Virtual – work at home

Humana’s dream is to help our members and our own associates achieve lifelong well-being. Use your clinical experience to work with patients and providers in a nontraditional environment where your knowledge will make a difference. Our associates know their work is vitally important; we strive to ensure we provide perfect service with one-on-one member interactions as a coach, personal nurse, or clinical advisor. Humana’s Perfect Service® means getting the basics done right, delivering value and quality, providing guidance on needs, and being engaged with our members. We want to help our members make the right choices to live life fully. We begin that process by connecting our members with an associate who cares.

Assignment Capsule

Humana is seeking a Clinical Auditor to identify, collect, assess, monitor and document claims and encounter coding information. Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis and procedure codes based on services rendered.

  • Review medical record information to identify all appropriate coding.
  • Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
  • Support and participate in process and quality improvement initiatives.

    Key Competencies

    Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.

    Pursues Excellence: Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to Humana.

    Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.

    Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first.

    Role Essentials

  • Current US RN License with Coding experience

  • 3 years of clinical experience within Home Health field
  • Previous experience in medical record reviews/auditing or extensive experience in Home Health
  • At least one of the following Certifications: Home Health- certified OASIS coder- HCS-O, HCS-D, COS-C
  • 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 and Excel
  • High level of emotional intelligence
  • Ability to work independently and manage work load
  • Comfortable working in a production based work environment

    Role Desirables

  • 3-5 years of auditing experience in Home Health.

  • Certified Professional Coder (CPC)

    Reporting Relationships You will report to a Manager . This area is under the leadership of the SVP & Chief Operating Officer.

    Additional Information

    At Humana, we know your well-being is important to you, and it

    is important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.

    After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.

Title: Home Health Clinical Auditor - RN

Location: OH-Cincinnati

Requisition ID: 191494

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.