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The RN Charge Auditor will execute clinical charge audits of medical records on behalf of Intermountain hospitals and clinics for denials review, defense audits, disallowed charges, and retrospective reviews, and will serve as clinical resource for all Intermountain Health Revenue Cycle departments. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, Massachusetts, Maine, Minnesota, New York, Pennsylvania, Rhode Island, Virginia Vermont, Washington.

Intermountain Health

Revenue Integrity Charge Auditor

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This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers.

Texas Children's Hospital

Medical Compliance Auditor

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Northern Light Health Department: Internal Audit Position is located: Cianchette Professional Blding Work Type: Full Time Hours Per Week: 40.00 Work Schedule: No Hours Assigned Salary Range: $35.92 - $55.13 Exempt: Yes Summary: Under the direction of the Director of Internal Audit, this position will plan and conduct audits of Northern Light Health and any of its members with a focus on clinical activities (e.g., coding, billing, safety, etc.), the safeguarding of assets, accuracy and reliability of data, and compliance with policies, procedures, and regulatory requirements to protect Northern Light Health from loss through error, fraud, or operational inefficiencies. Our care team-in hospitals, primary and specialty care practices, long-term and home healthcare, behavioral healthcare, and ground and air medical transport and emergency care-are committed to making healthcare work for you: our patients, communities, and employees.

HOUR

Northern Light Health

Medical Auditor/RN- Senior

We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology care and a vast scope of services located in the San Fernando Valley. Essential Functions: Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials.

Adventist Health

Chart Auditor - Glendale

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The Clinical Documentation Auditor will identify areas of improvement to fully, compliantly, and accurately reflect patient acuity through DRG assignment, severity of illness, risk of mortality and risk adjustment factors via primarily in-depth retrospective (post-discharge, prebill) audit of the patient's clinical record and related findings and queries performed by the Clinical Documentation Specialists. The combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care".

St. Joseph Health

Clinical Documentation Auditor

Preferred skills, qualifications and experiences: One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.

YEAR

Elevance Health Inc

Patient Safety DRG Clinical Validation Auditor

This role serves as a senior clinical compliance subject matter expert and performs advanced auditing, monitoring, and compliance validation activities to ensure adherence to Utilization Management (UM) and Population Health Management (PHM) Plans, Managed Services Agreements (MSAs), and value-based care program requirements. We encourage cross-training, ongoing development, and a commitment to learning across all areas of the business-ensuring we continue to grow as a high-performing, mission-driven team and you continue to grow and thrive as a member of our high-performing, mission-mission driven team.

Guidehealth

Clinical Compliance Auditor - Remote

Preferred Skills, Capabilities and Experiences: One or more of the following certifications are preferred: Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC. Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).

Diagnosis Related Group Clinical Validation Auditor

The role develops audit findings, recommends corrective and preventive actions, monitors remediation efforts, and collaborates with Revenue Cycle, Health Information Management (HIM), Coding, Patient Financial Services, Clinical Documentation Integrity (CDI), Compliance, Privacy, and Information Security teams to promote sustainable compliance and financial integrity. Essential Responsibilities: Comprehensive Revenue Integrity Auditing: Conduct routine, focused, retrospective, and risk-based audits across the healthcare revenue cycle, including patient registration, eligibility, authorization, charge capture, coding, billing, claims submission, payment posting, and account adjustments.

Hendricks Regional Health

Revenue Integrity Auditor Full Time Days

We are seeking a Senior Clinical Compliance Auditor to act as the primary clinical reviewer of analytical findings, complaints, formal referrals, and appeals related to the care or services provided by Network Hospitals, Providers, Pharmacies and other entities. Interpersonal skills that guide group dynamics from leading meetings and articulate clinical findings objectively, to guiding sensitive discussions, building consensus and gaining buy-in without direct authority.

Blue Cross & Blue Shield of Mississippi

Senior Clinical Compliance Auditor

tracking of internal audit results for all of PHS; enterprise-wide training of all PHS coding, audit, physician and clinician personnel; support via auditing and training the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers; insure the accuracy of defensive and proactive audits of medical records with billing and identifies and recommends actions related to discrepancies; responds and conducts medical record reviews requested by external regulatory agencies such as JCAHO, CMS and NMMRA as well as insurance companies such as PHP. With minimal supervision directly supports the following responsibilities of the Coding and documentation quality assurance (CDQA) team: implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS; compliance to all external regulatory agency coding rules and regulations; Demonstrates high-level of proficiency in performing and/or managing internal audits or reviews to assess compliance/quality monitoring performed by PHS departments while serving as a resource on documentation, billing, and clinical coding compliance questions.

Presbyterian System Services

Remote CPMA Educator & Auditor

License, Registration or Certification Required: Certification in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA), Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC), Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) or equivalent certifications. The Compliance Analyst/Auditor assists with the ongoing implementation and maintenance of SJRMC’s compliance program efforts; including, but not limited to: policy and procedure development, risk assessment, auditing and monitoring, training and education initiatives, and compliance programmatic developments and enhancements.

San Juan Regional Medical Center

Coding Compliance Auditor & Educator

Required Minimum Experience: Minimum 2 years working in an acute care setting as a Clinical Documentation Specialist (CDS) Required and Minimum 5 years healthcare experience Required and Prior experience of working as a CDI/Coding auditor is preferred Preferred and Prior experience of working in inpatient case management or utilization review is preferred Preferred and. a) Initiates audits and prepares findings to assist CDI Education Lead in preparing and providing regular CDI education to stakeholders based on findings, trends, industry events and based on management needs b) Audits medical records to determine opportunities as they relate to clinical documentation improvement, PSI, HACs, mortality, etc.

<p>As the largest healthcare system in the suburbs of Atlanta, WellStar serves more than a million patients a year within our hospitals, health parks, urgent care centers, and medical practices in NW Atlanta. We are a leading not-for-profit health system with state-of-the-art medical technology and a world-class employee family. Onsite concierge services, pension plans and job sharing are just the start of our innovative vision of a ‘Work Life Well Lived!’</p>

WellStar Health System Inc

Through our many years in the home care field we have seen when the customer and/or family has an active part in the planning and implementation in the plan of care, a sense of belonging and self-worth surfaces which ultimately produces increased quality of life, therefore enhancing the holistic healing process. We understand the concept of"Home"While providing quality professional medical care and understanding the importance of following guidelines and regulations, we spend much of our time focusing on the individual's vital role in having input and decision making freedom regarding their own healthcare.

Independence Home Health

Home Health Agency Auditor Assistant

Auditor Assistant

The Revenue Integrity Auditor is responsible for performing both concurrent and retrospective audits to ensure compliance with federal/state laws and managed care contract provisions. Initial training will take place at a Norton Healthcare facility, and you must be available to come onsite for business needs as required.

Norton Healthcare Foundation

Revenue Integrity Auditor, Revenue Integrity/Coding Administration, Flexible Hours, Days, Fully Remote

Consults with clinical operations leaders to identify, develop, and respond to training needs and requests Develops curriculum, maintains currency, and revises as appropriate Plan, coordinate, deliver, and evaluate clinical training for clinical operations programs, including: New hire onboarding. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry.  We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Blue Cross and Blue Shield Association

Clinical Trainer & Auditor - Remote AZ

FULL_TIME

OTHER

The Clinical Auditor I is a liaison and resource between WellSense Health Plan and external providers, working collaboratively with a diverse group, including management, physicians, clinical and non-clinical personnel. · Bachelor's degree in nursing or an equivalent combination of education, training, and experience is required OR Licensed Clinical Social Worker, Licensed Marriage Family Therapist or Licensed Mental Health Counselor.

WellSense Health Plan

Clinical Auditor I

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PART_TIME

Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.

CorVel Healthcare Corporation

Clinical Review Auditor I

Partners cross-functionally with internal teams and external network providers to identify compliance gaps, assess risks, recommend corrective actions, and drive continuous improvement while supporting a culture of accountability, transparency, and regulatory excellence. This role is different because the Auditor at WelbeHealth: Plays a critical role in strengthening WelbeHealth's compliance program by conducting internal and external audits, evaluating operational practices, and ensuring adherence to applicable federal, state, and PACE-specific regulatory requirements.

Nurse Auditor Jobs in the United States

Revenue Integrity Charge Auditor Intermountain Health

Medical Compliance Auditor Texas Children's Hospital

Medical Auditor/RN- Senior Northern Light Health

Chart Auditor - Glendale Adventist Health

Clinical Documentation Auditor St. Joseph Health

Patient Safety DRG Clinical Validation Auditor Elevance Health Inc

Clinical Compliance Auditor - Remote Guidehealth

Diagnosis Related Group Clinical Validation Auditor Elevance Health Inc

Revenue Integrity Auditor Full Time Days Hendricks Regional Health

Senior Clinical Compliance Auditor Blue Cross & Blue Shield of Mississippi

Remote CPMA Educator & Auditor Presbyterian System Services

Coding Compliance Auditor & Educator San Juan Regional Medical Center

Clinical Documentation Auditor WellStar Health System Inc

Home Health Agency Auditor Assistant Independence Home Health

Auditor Assistant Independence Home Health

Revenue Integrity Auditor, Revenue Integrity/Coding Administration, Flexible Hours, Days, Fully Remote Norton Healthcare Foundation

Clinical Trainer & Auditor - Remote AZ Blue Cross and Blue Shield Association

Clinical Auditor I WellSense Health Plan

Clinical Review Auditor I CorVel Healthcare Corporation

Auditor Welbe Health LLC

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