Clinical Auditor - RN - Remote

Overview

We are 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 is responsible for evaluating quality of care, reviewing medical records and program policies, identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities.

In Short

• Review medical records and related documentation for compliance.
• Conduct medical record and compliance reviews independently.
• Identify documentation deficiencies and billing compliance issues.
• Maintain detailed workpapers documenting audit procedures.
• Assist with audit responses and appeals as needed.
• Ensure compliance with healthcare and Medicaid guidelines.
• Stay current on clinical guidelines and Indiana Medicaid updates.
• Research Indiana Medicaid rules and maintain internal repositories.
• Adapt to changing priorities while maintaining accuracy.

Requirements

• RN license preferred; Indiana or compact license accepted.
• Coding certification such as CCS or CPC preferred.
• Located in or near Indianapolis preferred.
• 1 year of Medicaid claims review or billing compliance experience.
• Familiarity with Indiana Medicaid policies preferred.
• Knowledge of CPT coding and ICD-10 standards.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Strong analytical and problem-solving skills.
• Ability to work independently and collaboratively.
• Experience with healthcare providers preferred.

Benefits

• Flexible work environment.
• Opportunities for professional development.
• Diversity and inclusion initiatives.
• Collaborative team atmosphere.
• Support for work-life balance.