Registered Nurse Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor.

Key Responsibilities:

• Conduct detailed medical record audits for outpatient, inpatient, professional, and ancillary claims to ensure accurate reimbursement
• Identify documentation and billing issues, potential fraud, and recommend audit projects based on trends
• Train and mentor staff on audit protocols and update clinical audit guidelines

Required Qualifications:

• Bachelor's degree in Nursing or equivalent combination of education and experience
• Minimum of 2 years clinical claim/medical record auditing experience
• Minimum of 2 years RN experience in an acute care setting
• Coding Certification (CPC or CCS) required for Clinical Auditor II
• Valid Registered Nurse License required