The Quality Assurance, Clinical Professional 2 consults and collaborates with clinicians to ensure high accountability of compliance and quality. The Quality Assurance, Clinical Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Where you Come In
Do you enjoy or want to work from home? Do you have great attention to detail? Are you passionate about quality assurance? Are you looking for valuable experience working for a Fortunate 100 company that focuses on the well-being of their customers? Do you thrive in a fast-paced environment with flexible hours? Well, if you answered YES to one or more of the above you should strongly consider the Clinical Quality Assurance Professional 2 opportunity with Humana.
The Quality Assurance, Clinical Professional 2 selects claims through random processes and/or other criteria. 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. Completes quality audits on a variety of claims to ensure proper clinical decisions were applied.
What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.
Required Qualifications - What it takes to Succeed
o Associate Degree
o Active Registered Nurse (RN) license in state of residence
o Certified Medical Coder through either AHIMA or AAPC
o Medical record review experience
o Proficient in MS office applications including Word, Excel, Outlook, PowerPoint
o Demonstrated ability to work independently and manage work load
o Strong critical thinking skills
o Exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
o Organized and strong attention to detail
o Excellent writing, editing, interpersonal, planning, teamwork, and communication skills
o Bachelors Degree
o Specialized knowledge of laboratory and genetic testing
o Previous Quality Auditing experience - strongly preferred
o Nurse Auditor experience
Additional Information - How we Value You
Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Go365 perks for well-being
Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.
Scheduled Weekly Hours