Clinical Auditor RN

Focused on auditing outpatient and specialty claims, the full-time Clinical Auditor RN will utilize coding and clinical chart validation expertise to ensure accuracy, medical necessity, and appropriateness of services delivered, while working in a remote environment. Key responsibilities Conducts audits on outpatient and specialty claims using medical chart coding principles and client-specific guidelines Utilizes advanced coding knowledge and audit tools to identify billing and coding issues, ensuring compliance with standards Recommends improvements and new concepts to enhance audit processes and client satisfaction based on extensive healthcare auditing experience Required qualifications Associate or bachelor's degree in nursing with an active/unrestricted license Coding certification (e.g., CPC, CIC, CCS) required and maintained 5 to 7 years of experience in clinical medical record coding or auditing In-depth knowledge of HIPAA Privacy and Security Rules and CMS requirements Expertise in coding guidelines, including DRG, ICD-10, CPT, and HCPCS codes