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 medical record audits, analyze clinical data, and develop comprehensive audit reports while collaborating with clinical staff and providers.

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
• Conduct audits and develop reports outlining findings, discrepancies, and actionable recommendations for improvement

Required qualifications:

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