Clinical Auditor (Remote)

Registered Nurse or Enrolled Nurse (preferred). Highly experienced in ICD-10 and CPT coding. Highly experienced in insurance billing. Knowledge of Medicare, BCBS, Aetna, and other major payers. Sharp eye for detail and tracking inconsistencies. Thrive working independently in a quiet, remote setting. Communicate clearly, tactfully, and effectively. Experience in clinical auditing, compliance, or quality assurance (bonus). Familiarity with EHR systems and audit tools (bonus). Relevant certification (like CHC or CHCA) (bonus).

Conduct internal audits of clinical documentation for accuracy and compliance. Review billing practices for Medicare, Aetna, BCBS, and other major payers. Identify discrepancies and provide recommendations. Educate and train providers and staff on documentation best practices. Stay ahead of changes in coding standards and payer requirements. Produce clear, concise audit reports for leadership. Work independently from home, managing schedule and priorities.