Registered Nurse Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor/Analyst Intermediate who will conduct clinical audits and reviews related to care analysis and compliance.

Key Responsibilities

• Conduct clinical audits and reviews to ensure compliance with coding and regulatory requirements
• Utilize fraud detection software to assess potential fraud, waste, and abuse
• Analyze claims and medical records to provide clinical opinions on appropriate service utilization

Required Qualifications

• Registered Nurse (RN) with a Bachelor of Science in Nursing (BSN) or equivalent experience
• Five years of clinical experience and three years in fraud & abuse auditing or related fields
• In-depth knowledge of medical terminology, ICD-10, and CPT-4 coding
• Proficiency in Microsoft Office products
• AAPC or AHIMA certification required