Clinical Auditor - Registered Nurse (RN)

Position Summary

We are dedicated to bringing accuracy, accountability, and clinical excellence to healthcare. As a leading authority in payment integrity solutions, we are seeking a passionate and experienced registered nurse to join our Hospital Bill Review Department. This role focuses on performing bill reviews and chart validations, contributing to our mission of ensuring high-quality healthcare.

About You

You are a highly motivated individual with a strong clinical and auditing background. Your excellent communication skills and analytical mindset will help you thrive in our fast-paced environment. You will enjoy a flexible, full-time position (37.5 hours per week) from Monday to Friday, with the option to telecommute from anywhere within the United States. Training will be conducted virtually from your home.

Qualifications

• Must be a registered nurse with an active RN license.
• BSN or equivalent required.
• 2-5 years of auditing experience preferred; we will also consider candidates with experience in Utilization Review, Managed Care, or Case Management.
• 2-5 years of experience in either Medical Surgical or Critical Care required.
• Proficient in using Windows PC with the ability to navigate multiple applications simultaneously.
• Excellent computer skills.
• Knowledge of appeals and CMS guidelines preferred.
  
  

Responsibilities

• Detail-oriented with strong organizational skills.
• Solid understanding of anatomy and physiology, as well as diagnostic and surgical procedures.
• Ability to accurately interpret medical records and transcriptions.
• Write clear, accurate, and concise clinical notes to support findings.
• Maintain and manage case reviews with a focus on quality.
• Work efficiently in a high-volume production environment.
• Knowledge of health insurance business, industry terminology, and regulatory guidelines.
• Accurately interpret plan policies and apply them appropriately during clinical audits.
• Communicate effectively both orally and in writing.
• Complete appeal reviews as needed.
• Perform care reviews utilizing Interqual guidelines.
• Maintain and update hospital profiles as necessary.
  
  

Remote Work Requirements

• High-speed internet (recommended 100 Mbps per person) with secured Wi-Fi.
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Ability to sit and use a computer keyboard for extended periods.
  
  

Benefits And Perks

• Healthcare: Excellent medical, dental, and vision plan options to fit your needs.
• 401(k) with Employer Match: Join our team, and we will invest in your future.
• Generous Paid Time Off: Accrued PTO starting from day one, plus additional days off when you're not feeling well or to observe holidays.
• Wellness: We care about your well-being, offering benefits from commuter options to FSAs.
• Learning & Development: Focused on your growth as a professional through continued education, mentorship, and access to LinkedIn Learning.
• Salary: \(80,000 - \)90,000.
  
  

Employment Type: Full-Time