Home Health Auditor Nurse

Job Summary

Working remotely in a full-time capacity, the Home Health Auditor Nurse will perform medical claims audit reviews, focusing on the Home Health sector, while collaborating with a team to ensure compliance with medical review guidelines and support during the appeals process.

Key Responsibilities:

• Auditing claims for medically appropriate services and documenting findings according to established guidelines
• Generating letters to articulate audit findings and supporting those findings during appeals if necessary
• Collaborating with the audit team to identify vulnerabilities and improve audit workflows

Required Qualifications:

• Active/unrestricted RN license with an associate or bachelor's degree in nursing
• Minimum of 2 years of experience in Home Health claims auditing or related fields
• Strong knowledge of ICD-9, ICD-10, CPT-4, or HCPCS coding
• Experience with utilization management systems or clinical decision-making tools
• Ability to work independently and efficiently in a remote environment