Registered Nurse Clinical Auditor

Job Summary

To support a growing health insurance organization, the full-time remote Registered Nurse Clinical Auditor will perform detailed chart audits, ensuring accuracy of billed charges against medical documentation while collaborating with providers and internal teams.

Key responsibilities:

• Utilizes knowledge of CPT, ICD-10, and HCPCS codes to verify billed services against medical records
• Identifies documentation and billing issues, and assesses provider coding for accuracy
• Documents audit findings and communicates with providers regarding audit results and recommendations

Required qualifications:

• Bachelor's degree in nursing or equivalent combination of education and experience required
• Valid license as a Registered Nurse or equivalent clinical license required
• Minimum of two years of experience in case management, utilization review, or claims auditing
• Knowledge of CPT, ICD-10, and HCPCS coding preferred
• Coding certification (CPC or CCS) preferred