Clinical Auditor Licensed RN

Job Summary

Focused on Coding and Clinical Chart Validation, the full-time Clinical Auditor Licensed RN will independently audit outpatient and specialty claims, ensuring coding accuracy and medical necessity while utilizing advanced audit tools and maintaining productivity standards.

Key responsibilities

• Conduct audits of outpatient and specialty claims by applying medical chart coding principles and client-specific guidelines
• Utilize advanced proficiency in audit tools to enter claims accurately and meet established productivity and quality standards
• Identify potential new claim types for additional recoveries and recommend improvements in auditing processes and concepts

Required qualifications

• Associate or bachelor's degree in nursing with an active/unrestricted license
• Coding certification (e.g., CPC, CIC, CCS, CCS-P, RHIA, or RHIT) required and maintained
• 5 to 7 years of experience in clinical medical record coding or auditing
• Broad knowledge of medical claims billing/payment systems and coding terminology
• Expert knowledge of coding guidelines, including DRG, ICD-10, CPT, and HCPCS codes