UNKNOWN

FEED

2+ years of working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology. The Clinical RN Chart Reviewer will report to the Payment Assurance Manager and support a culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission.

ProgenyHealth, Inc.

Nurse Inpatient Coding Auditor, (Remote) CIC or CCS certified

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FULL_TIME

OTHER

PACS business support division, PACS Services, provides technology and administrative support services — accounting, finance, human resources, compliance, payroll, AR/AP, legal, risk management, information technology, corporate communication, and other business advice and support — to their healthcare facilities, reducing administrative burdens so their leadership and care teams can focus on the care, well-being, and quality of life of their patients and residents. Reporting to the Senior Director of Clinical Audit, the Clinical Compliance Auditor II is an advanced-level compliance professional responsible for conducting comprehensive clinical audits of clinical documentation, regulatory compliance practices, and reimbursement related processes related to Skilled Nursing Facilities and related post‑acute care settings.

PACS

Clinical Compliance Auditor - Nurse

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Denials Analysis & Appeals • Analyze invoices and patient accounts in the patient accounting system to prepare appeals for third-party payer denials • Utilize Explanation of Benefits (EOB) and Remittance Advices to verify denials and identify appeal opportunities • Review denied services for retrospective approval, continued access needs, retrospective review, and defense audits • Identify and evaluate denial trends that impact reimbursement and revenue cycle performance. Payer Communication & Resolution • Contact third-party payers, insurance medical directors, case management, and utilization review teams to request reconsideration and appeals • Provide comprehensive clinical and financial documentation to support appeal requests • Coordinate appeal and audit activities and maintain timely follow-up on appealed or audited claims • Communicate issues affecting future care needs and contract performance to leadership.

YEAR

University of Texas MD Anderson Cancer Center

Nurse Defense Auditor

This role utilizes clinical expertise to review patient records within the Epic electronic health record to ensure implants, supplies, medications, and procedural services are accurately documented and charged. 1. Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).

WVU Medicine

RN Charge Auditor

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MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC). This role utilizes clinical expertise to review patient records within the Epic electronic health record to ensure implants, supplies, medications, and procedural services are accurately documented and charged.

West Virginia University Medicine

When determining a team members base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.

Northwell Health Inc

Registered Nurse Coding Auditor

Collaborates with other Moda areas to provide clinical policy representation at meetings to ensure that decisions, which affect claim processing, are appropriate and will result in cost effective, efficient, and accurate claims payment. Communicates claim payment decisions to processing staff and recommends and coordinates processes to review large dollar hospital claims.

Moda Partners Inc

RN Hospital Claims Auditor

Employees may also be asked to complete certain compliance requirements set forth by our Business Partners in the performance of their jobs including but not limited to requests for background and drug screenings and disclosures of personal health information or personally identifiable information. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information.

Trend Health Partners Inc

Nurse Coder DRG Auditor III

Final offers are based on several factors, including: the candidate''s skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. What You'll Be Doing: Review inpatient medical records to verify that the DRG (Diagnosis-Related Group) code makes sense based on the documentation.

ExlService Holdings Inc

Clinical Validation Auditor (CVA) Auditor III

ADAPTED_NOW

DRG Validation Auditors are charged with rendering appropriate, well-supported, and thoroughly-documented decisions, which may result in identification of improper payments (overpayments and underpayments) on paid claims on behalf of the client from various providers of clinical services, including but not limited to acute care, long-term acute care, acute rehabilitation, and skilled nursing facilities, as well as other provider types and care settings. As members of the DRG Validation Team and working remotely, incumbents will be responsible for reviewing medical records to determine the accuracy of coding and reimbursement for clinical services rendered to beneficiaries of various health plans, including Commercial, Medicare, and Medicaid Clients.

MMC Group

DRG Auditor

SmartSearch

Race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate shall not be a factor in employment for this position. Directs the charge capture auditing program, including concurrent, retrospective and random audits of patient accounts compared to the medical record to ensure charges are complete, accurate and compliant.

Hunt Regional Healthcare

Auditor Charge Capture Manager- Patient Financial Services FT

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<p><span>Kratos Defense & Security Solutions, Inc.</span> (Nasdaq:KTOS) is a specialized Technology Company providing mission critical products, solutions and services for United States National Security. Kratos' core capabilities are sophisticated engineering, manufacturing and system integration offerings for National Security platforms and programs. Kratos' areas of expertise include Command, Control, Communications, Computing, Combat and Intelligence, Surveillance and Reconnaissance (C5ISR) systems, satellite communications, electronic warfare, unmanned systems, hypersonic systems, directed and high power energy systems, electromagnetic railgun, missile defense, cyber warfare, cybersecurity, information assurance, and critical infrastructure security. Kratos has primarily an engineering and technically oriented work force of approximately 3,100. Substantially all of Kratos' work is performed on a military base, in a secure facility or at a critical infrastructure location.</p>

Kratos Defense & Security Solutions Inc

IT Internal Auditor

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IT Internal Auditor (Temporary/Full-Time)

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. ICU, Critical Care, Emergency Department, Hospitalist, Case Management, Utilization Review, or CDI experience.

HOUR

Pyramid Consulting, Inc

Clinical Documentation Consultant (CDI) DRG Validation / Auditor

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The Internal Auditor will work closely with the Corporate Compliance and Audit team to better understand and respond to Compliance concerns affecting areas of responsibility, assist in identifying potential areas of compliance vulnerability and risk as it relates to the System's mission, and provide an independent and objective review of evidence that eithersupports or refutes the System's claim of compliance as it related to these areas. This responsibility includes performing internal audit procedures to support audit objectives and scopes, gathering supporting audit evidence and preparing internal audit documentation to reflect the work performed and conclusions reached.

Albany Medical Center

Internal Auditor - Compliance & Audit Department

IRecruitee

The Medical Claims Auditor must demonstrate a coder's aptitude, proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer's perspective. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360

Medical Claims Auditor

Talent Acquisition

Follows and supports and Magna's operating principles, including: Magna Employee Charter - Operating under its principles by treating all team members equally, fairly and with dignity and respect. Review quality alerts and issues on Quick Issue Detection Sheet (QID) at start of new shift, change over, or change in manpower with production associates on assigned lines.

We are a leading global automotive supplier with 347 manufacturing facilities and 94 product development, engineering and sales centres in 27 countries. We have over 159,000 employees focused on delivering superior value to our customers through innovative processes and World Class Manufacturing.

Magna International, Inc

Quality Auditor

Broadbean

MAP Quality Auditor

Headquartered in Burlington, MA, with additional office locations and hybrid and remote workers in cities across the U.S., Ascend Learning was recognized by Newsweek and Plant-A Insights Group as one of America's 2025 Greatest Workplaces as well as America's Best Places to work for Mental Well-Being for 2025. Execute walkthroughs, develop process narratives and flowcharts, and perform testing of key controls for design and operating effectiveness, incorporating data analytics and AI tools to strengthen audit results, increase efficiency, and enhance business processes.

Ascend Learning LLC

Sr Internal Auditor

May assume the role of CDS as demands for services requires, entailing the following: Conducts new inpatient admissions reviews and proper working DRG assignment within 2 working days; Conducts follow up reviews and respective working DRG updates at least every 2 working days. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

Nurse Auditor Jobs in the United States

Nurse Inpatient Coding Auditor, (Remote) CIC or CCS certified ProgenyHealth, Inc.

Clinical Compliance Auditor - Nurse PACS

Nurse Defense Auditor University of Texas MD Anderson Cancer Center

RN Charge Auditor WVU Medicine

RN Charge Auditor West Virginia University Medicine

Registered Nurse Coding Auditor Northwell Health Inc

RN Hospital Claims Auditor Moda Partners Inc

Nurse Coder DRG Auditor III Trend Health Partners Inc

Clinical Validation Auditor (CVA) Auditor III ExlService Holdings Inc

DRG Auditor MMC Group

Auditor Charge Capture Manager- Patient Financial Services FT Hunt Regional Healthcare

IT Internal Auditor Kratos Defense & Security Solutions Inc

IT Internal Auditor (Temporary/Full-Time) Kratos Defense & Security Solutions Inc

Clinical Documentation Consultant (CDI) DRG Validation / Auditor Pyramid Consulting, Inc

Internal Auditor - Compliance & Audit Department Albany Medical Center

Medical Claims Auditor Imagine360

Quality Auditor Magna International, Inc

MAP Quality Auditor Magna International, Inc

Sr Internal Auditor Ascend Learning LLC

Senior Clinical Documentation Specialist Auditor - Clinical Doc Integrity - Full Time 8 Hour Days (Non-Exempt) (Non-Union) University of Southern California

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