Clinical Auditor RN

Job Summary

Focused on auditing outpatient and specialty claims, the full-time Clinical Auditor RN will utilize coding and clinical chart validation expertise to ensure accuracy, medical necessity, and appropriateness of services delivered, while working in a remote environment.

Key responsibilities

• Conducts audits on outpatient and specialty claims using medical chart coding principles and client-specific guidelines
• Utilizes advanced coding knowledge and audit tools to identify billing and coding issues, ensuring compliance with standards
• Recommends improvements and new concepts to enhance audit processes and client satisfaction based on extensive healthcare auditing experience

Required qualifications

• Associate or bachelor's degree in nursing with an active/unrestricted license
• Coding certification (e.g., CPC, CIC, CCS) required and maintained
• 5 to 7 years of experience in clinical medical record coding or auditing
• In-depth knowledge of HIPAA Privacy and Security Rules and CMS requirements
• Expertise in coding guidelines, including DRG, ICD-10, CPT, and HCPCS codes