Clinical Auditor, RN

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in conducting reviews of medical records and billing compliance audits for the Indiana Health Coverage Programs.

• Assess the quality of care by examining medical records and program policies while identifying compliance-related issues.

• Draft audit documentation and reports, and provide support for appeals processes.

• Perform medical record and compliance evaluations independently and share preliminary findings with the Lead Reviewer.

• Detect potential documentation gaps and billing compliance concerns.

• Keep comprehensive workpapers that detail the procedures performed, records assessed, findings discovered, and conclusions drawn.

• Offer assistance with audit responses and appeals as necessary.

• Ensure that all tasks adhere to state, federal, and national healthcare and Medicaid regulations.

⛳️ Requirements

• Preferred RN license; Indiana license or compact license is acceptable.

• Strong preference for coding certification such as CCS or CPC.

• Minimum of 1 year of experience in Medicaid claims review, billing compliance, or healthcare reimbursement.

• Preferred familiarity with Indiana Medicaid policies, payer guidelines, and documentation standards.

• Knowledge of CPT coding guidelines and ICD-10 standards is required.

• Proficient in Microsoft Excel, Word, and Outlook.

• Strong analytical, critical thinking, problem-solving, and technical writing abilities.

• Capability to work both independently and collaboratively in a fast-paced setting.

• Preferred experience working with healthcare providers.

• Familiarity with healthcare claims data and issues related to fraud, waste, and abuse is advantageous.

🏝️ Benefits

• Solutions arise from innovative ideas; creativity thrives on embracing differences.

• Briljent is committed to diversity and inclusion as essential components of the company's success.

• We uphold a policy of non-discrimination against any employee or applicant based on race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status, or any other basis protected by federal, state, or local law, regulation, or ordinance.