Registered Nurse Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor I.

Key Responsibilities:

• Analyze patient records and medical billing documents for accuracy and compliance with healthcare standards
• Verify coding accuracy using appropriate CPT, HCPCS, and ICD-10 codes and ensure adherence to guidelines
• Conduct audits and develop comprehensive reports outlining findings and recommendations for improvement

Required Qualifications:

• Bachelor's degree in nursing or equivalent combination of education and experience
• Two years of experience in clinical health insurance roles, such as case management or claims auditing
• Minimum of two years RN experience in an acute care setting
• Behavioral Health and/or DRG experience required
• Valid Registered Nurse License required; coding certification preferred