State Licensed Clinical Auditor (RN)

Job Summary

A company is looking for a Clinical Documentation & Coding Auditor (RN).

Key Responsibilities:

• Perform concurrent and retrospective reviews of clinical documentation and coded data for inpatient and outpatient encounters
• Validate alignment between provider documentation and assigned codes, ensuring appropriate code selection and medical necessity
• Collaborate with revenue cycle stakeholders to identify documentation and coding issues and support Revenue Integrity initiatives

Required Qualifications:

• Active, unrestricted Registered Nurse (RN) license in a U.S. state or territory
• 5+ years of clinical nursing experience, including 3+ years in documentation review or medical coding
• Strong knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems and guidelines
• Understanding of DRG and APC payment methodologies and their impact on reimbursement
• Experience with major EHR systems, such as Cerner or Epic