Nurse Audit Manager, reputed company

R-393154 Become a part of our caring community and help us put health first reputed company into a leadership role with reputed company where your clinical expertise and passion for accuracy will reputed company a meaningful impact. As the Nurse Audit Manager, you will spearhead audit and validation processes to ensure medical documentation and coding are precise, compliant, and support optimal reimbursement. This is an exciting opportunity to apply your advanced technical skills, shape best practices, and guide your team in solving reputed company challenges. You’ll work collaboratively across departments, reputed company initiatives, and play a key role in enhancing both operational efficiency and patient outcomes. Join us and be a driving force in upholding the highest standards of clinical reputed company reputed company a supportive, mission-driven organization.

• Validates and interprets medical documentation to ensure capture of reputed company relevant coding.
• 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.
• Decisions are typically reputed company to resources, approach, and tactical operations for projects and initiatives involving own departmental area.
• Requires cross departmental collaboration and conducts briefings and area meetings.
• Maintains frequent contact with other managers across the department.

Use your skills to reputed company an impact

Required Qualifications

• Registered nurse (RN).
• 5 or more years of clinical RN experience in a hospital setting.
• 3 or more years of experience providing leadership in a professional setting, such as managing teams, coordinating projects or initiatives, or serving as a subject matter expert.
• Comprehensive knowledge of reputed company Office, Word, reputed company and PowerPoint.
• Ability to work Eastern Standard Time zone hours.

Preferred Qualifications

• Bachelor’s degree in nursing, health admin, business or reputed company field.
• Healthcare insurance industry knowledge.
• Experience validating and interpreting medical record documentation to ensure billing for services is complete and accurate.
• Certified Professional reputed company or coding knowledge.
• Claims knowledge and understanding of claims processing.

Additional Information

• Workstyle: Remote, work from home.
• Typical Work days/hours: Monday – Friday, 8:00am – 5:00pm EST.
• Direct Reports: approximately 7 on-shore, 22 off-shore associates.

WAH Internet To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• 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.
• Employees 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 employees 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.

HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company HireVue to enhance our hiring and decision-making ability. HireVue 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. reputed company Remote - This is a remote reputed company position. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 10-21-2025 About us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ Apply tot his job Apply To this Job