Registered Nurse Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor/Analyst Intermediate to conduct clinical audits and reviews in the Fraud, Waste & Abuse department.

Key Responsibilities

• Conduct clinical audits and reviews related to coding, regulatory requirements, and resource utilization
• Utilize fraud detection software to analyze claims and medical records for compliance and appropriateness
• Act as a subject matter expert, providing training and support to new staff and auditing peers

Required Qualifications

• Registered Nurse (RN) with a Bachelor of Science in Nursing (BSN) or equivalent experience
• Five years of clinical experience
• Three years of experience in fraud & abuse, auditing, or quality review
• In-depth knowledge of medical terminology, ICD-10, and CPT-4 coding
• AAPC or AHIMA certification (CPC, CPMA, CIC, CCA, CCS, CCS-P) required