RN Clinical Auditor

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

📋 Description

• Conduct thorough clinical audit evaluations for government entities (MAC, CERT, RAC, OIG, ZPIC, UPIC, QIO, TPE, DRG), state programs (Medicaid, PERM), and commercial payers (Managed Medicare, Charge/Defense, Level of Care, Medical Necessity, Readmission).

• Aid in the analysis and assessment of clinical audit and DRG clinical validation audits.

• Liaise with regulatory agencies such as MACs and payers to ascertain the reasons behind the audits.

• Examine medical records to verify adherence to healthcare standards and regulations.

• Evaluate medical records and data to spot trends and inconsistencies.

• Collaborate effectively with healthcare providers, management, and various departments.

⛳️ Requirements

• Over 2 years of experience in regulatory audits, utilization review, clinical validation, denials, or case management is highly preferred.

• Background in hospital operations, chart audits/reviews, and clinical education.

• Proficient in time management, meeting audit deadlines, and juggling multiple responsibilities.

• Knowledge of electronic medical records (EMR) systems is essential.

• A Registered Nurse (RN) license is mandatory.

🏝️ Benefits

• Bonus Incentives

• Paid Certifications

• Tuition Reimbursement

• Comprehensive Benefits

• Career Advancement