Clinical Auditor RN Licensed

Job Summary

Focusing on Coding & Clinical Chart Validation, the full-time Clinical Auditor RN Licensed will audit outpatient and specialty claims, ensuring clinical review, coding accuracy, and medical necessity while working remotely.

Key responsibilities

• Audits outpatient and specialty claims using medical chart coding principles and client-specific guidelines
• Effectively utilizes audit tools and maintains productivity and quality standards
• Identifies new claim types and recommends process improvements 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
• Broad knowledge of medical claims billing/payment systems and coding terminology
• Expert coding knowledge in DRG, ICD-10, CPT, and HCPCS codes