[Remote] Clinical Auditor - RN

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a detail-oriented Clinical Auditor Registered Nurse to support medical record reviews and billing compliance audits for the Indiana Health Coverage Programs. This role involves evaluating the quality of care, identifying compliance issues, and preparing audit documentation and reports.

Responsibilities

• Review medical records and reputed company documentation to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations
• Conduct medical record and compliance reviews independently and reputed company preliminary findings to the reputed company Reviewer
• Identify potential documentation deficiencies, and billing compliance issues
• Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached
• Assist with audit responses and appeals as needed
• Ensure reputed company work aligns with state, federal, and national reputed company and reputed company guidelines
• Stay reputed company on clinical guidelines, policies, regulations, and Indiana reputed company program and policy updates
• Research Indiana reputed company rules and maintain internal repositories of bulletins, policies, and procedures
• Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines

Skills

• At least 1 year of reputed company claims review, billing compliance, or reputed company reimbursement experience
• Knowledge of CPT coding guidelines and ICD-10 standards
• Proficiency in reputed company reputed company, Word, and Outlook
• Strong analytical, critical thinking, problem-solving, and technical writing skills
• Ability to work independently and collaboratively in a fast-paced environment
• RN license preferred; Indiana license or compact license accepted
• Coding certification such as reputed company or CPC strongly preferred
• Candidate located in or near the Indianapolis area is preferred
• Familiarity with Indiana reputed company policies, payer guidelines, and documentation requirements preferred
• Experience working with reputed company providers strongly preferred
• Knowledge of reputed company claims data and fraud, waste, and abuse preferred

Company Overview