Nurse Auditor
Core
Validates medical record documentation and diagnosis coding to ensure accuracy and compliance for optimal reimbursement; identifies high-risk members for disease management follow-up.
Role type
Senior clinical auditor (nursing background)
Builds
Accurate medical records and compliant billing data
Domain
Healthcare administration / Medical coding
Required skills
Active RN license, acute inpatient ICU/CCU experience, complex medical diagnosis knowledge, MS Office proficiency, independent judgment
Preferred skills
Inpatient coding certification (RHIA/RHIT/CCS), DRG auditing experience, Clinical Documentation Improvement (CDE) knowledge
Technologies
MS Office (Word, Excel)
Responsibilities
Validate and interpret medical documentation for coding accuracy; identify high-risk CMS HCC members for follow-up; conduct root cause analysis on audit findings; review provider codes and billing; apply clinical experience to coding reviews.
Seniority
Mid-level, independent contributor