Nurse Auditor 2 -- REMOTE/WORK AT HOME (ANYWHERE IN THE US/PR)

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 and independent determination of the appropriate courses of action.

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.

Use your skills to make an impact
 

Required Qualifications – What it takes to Succeed 
• Minimum of Associate Degree; Active Registered Nurse license (RN) in the state/territory in which they reside
• Minimum of 2 years acute inpatient hospital care experience or inpatient auditing experience in the last 5 years
• Familiarity with MS Office (Word, Excel, etc)
• Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
• Ability to work independently and manage work load
• Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession

HOURS: M-F, 8 hours per day/5 days per week. Work is performed between 6AM-6PM in employee's time zone (EST/CST/MST/PST). Overtime is occasionally offered, but no weekends/holidays.

Preferred Qualifications
• Bachelor’s Degree in relevant field preferred 

• Inpatient coding certification (AHIMA or AAPC – ex: RHIA, RHIT, CCS, CIS, CIC)    
• 2 years inpatient coding experience
• Acute inpatient hospital care experience or inpatient auditing experience in ICU, ER, Trauma or CVOR

• Prospective payment methodologies, auditing experience
• Clinical documentation improvement knowledge

Additional Information - How we Value You
• Benefits starting day 1 of employment 
• Competitive 401k match  
• Generous Paid Time Off accrual  
• Tuition Reimbursement 
• Parent Leave 
• Go365 perks …