Registered Nurse Audit Policy Analyst

Job Summary

To support the Complex Payment Solutions Team, the full-time Registered Nurse Audit Policy Analyst will lead the development, maintenance, testing, and optimization of payment integrity audit concepts while collaborating with cross-functional teams in a remote environment.

Key responsibilities

• Review and update audit concepts in response to regulatory changes and conduct research to assess their impact
• Perform QA reviews and validate audit concepts against coding guidelines and payer policies before deployment
• Manage multiple audit workflows, ensuring consistent application of policies and delivering results on time

Required qualifications

• Bachelor's degree in health administration, business, nursing, or a related field, or equivalent experience
• Minimum 5+ years of experience in healthcare claim type specialty with direct experience in payment integrity and claims auditing
• Registered Nurse or Certified Coder holding a nationally recognized credential (RHIA, RHIT, AHIMA, AAPC, or equivalent) required
• Demonstrated knowledge of ICD-10-CM, CPT, HCPCS coding systems, and various payment methodologies
• Proven ability to manage multiple concurrent workflows independently in a remote environment