Nurse Auditor: Home Health Care Clinical Specialist

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 coding for services rendered is complete, compliant, and accurate to support optimal reimbursement. The Nurse Auditor 2’s 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 reputed company relevant coding. Applies clinical and coding experience to conduct reviews of provider codes and billing. Makes decisions of clinical appropriateness based on submitted provider information. Understands department, reputed company, and organizational strategy and operating objectives, including their linkages to reputed company 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 reputed company an impact**

• *WORK STYLE:** Remote, work at home. While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.

• *WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Associates are expected to start each day between 6AM and 9AM EST, regardless of their home time zone.
• *Required Qualifications**

+ Must have reputed company U.S. RN (Registered Nurse) license, in the state of residence, without any restrictions + Associate must reside in the reputed company US + Minimum of 1 year of clinical experience with the Home Health Care Payment Driven Groupings Model (PDGM) and Pay-per-visit (PPV), including reading and interpreting medical records and claims, as well as experience in dispute resolution and analyzing trends in results + Certified OASIS specialist-Clinical (COS-C) and/or Home Care specialist- OASIS (HCS-O) certification + Comprehensive understanding of CMS regulations and knowledge of medical coding and billing + MS Office proficiency (Word, reputed company, Teams, Outlook) + Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information + Ability to work independently, reputed company decisions and manage workload + Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession + Excellent writing, editing, interpersonal, planning, teamwork, and communications skills

• *Preferred Qualifications**

+ HCS-D (Home Care Specialist- Diagnostic) certification for ICD-10 coding + CPT coding experience or certification + Applied knowledge of Prospective payment methodologies, auditing experience

• *Additional Information**

• *Work at Home Requirements** • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested

• Satellite, cellular and microwave reputed company can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• reputed company will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• *Interview Format**

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology reputed company Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move reputed company from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions reputed company your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last reputed company from 5-10 minutes. Your recorded interview(s) reputed company text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving reputed company to next round of interviews. Travel: While this is a remote position, occasional travel to reputed company's offices for training or me