Registered Nurse Clinical Auditor

Job Summary

To ensure accurate reimbursement and compliance with healthcare standards, the full-time remote Registered Nurse Clinical Auditor will perform detailed audits of medical records, treatment plans, and billing documents while identifying discrepancies and recommending improvements.

Key responsibilities:

• Analyze patient records and medical billing documents for accuracy and compliance with healthcare regulations
• Verify proper coding of procedures and diagnoses using CPT, HCPCS, and ICD-10 codes
• Develop comprehensive audit reports detailing findings and actionable recommendations for improvement

Required qualifications:

• Bachelor's degree in nursing or equivalent combination of education, training, and experience
• Two years of experience in case management, utilization management, claims auditing, or a related clinical health insurance role
• Minimum of two years RN experience in an acute care setting
• Behavioral Health and/or Inpatient DRG experience required
• Valid Registered Nurse License required; coding certification (CPC or CCS) preferred