Clinical Auditor RN

Job Summary

A company is looking for an Auditor Clinical Validation Outpatient Specialty Clinical.

Key Responsibilities

• Audit outpatient and specialty claims using medical chart coding principles and client-specific guidelines
• Utilize advanced audit tools and maintain productivity, accuracy, and quality standards
• Identify new claim types and recommend improvements to audit processes and concepts

Required Qualifications

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