Registered Nurse, Clinical Auditor

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

📋 Description

• Evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other relevant standards and regulations by reviewing medical records and associated documentation.

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

• Detect potential documentation gaps and billing compliance issues.

• Maintain comprehensive workpapers that document procedures undertaken, records examined, findings uncovered, and conclusions drawn.

• Provide assistance with audit responses and appeals as necessary.

• Ensure all tasks are in accordance with state, federal, and national healthcare and Medicaid guidelines.

• Keep updated on clinical guidelines, policies, regulations, and updates to the Indiana Medicaid program and policy.

• Research Indiana Medicaid rules and manage internal repositories of bulletins, policies, and procedures.

• Adapt swiftly to evolving priorities, policies, regulatory changes, and review requirements while ensuring accuracy and adherence to deadlines.

⛳️ Requirements

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

• Coding certification such as CCS or CPC is highly preferred.

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

• Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements is preferred.

• Understanding of CPT coding guidelines and ICD-10 standards.

• Proficient in Microsoft Excel, Word, and Outlook.

• Strong skills in analytical thinking, critical analysis, problem-solving, and technical writing.

• Capable of working independently as well as collaboratively in a dynamic environment.

• Experience interacting with healthcare providers is strongly preferred.

• Knowledge of healthcare claims data and issues related to fraud, waste, and abuse is preferred.

🏝️ Benefits

• Wellness programs

• Professional development opportunities