Clinical Audit Response Specialist

Location: United States; 100% remote off site

Salary: $110,200–$122,300 per year

Company

hirify.global conducts cancer research and provides patient care, education, and public-health programs.

What you will do

• Coordinate responses to external government and commercial payer charge and coding audits.
• Review medical records, clinical documentation, billing requirements, and audit findings.
• Prepare audit responses and clinical appeals, maintain audit records, and communicate with external auditors.
• Monitor payer policies covering coverage determinations, prior authorization, medical necessity, site-of-service rules, and benefits.
• Develop internal controls, improve audit-response workflows, and train staff on compliance procedures.
• Build dashboards and financial reports to monitor audit results, revenue cycle performance, and trends.

Requirements

• Associate’s Degree in Nursing required; Bachelor’s Degree in Nursing preferred.
• Five years of case management experience in acute care and/or insurance-based utilization review, clinical prior authorization review, or clinical appeals experience.
• Experience with government payer billing and follow-up, Medicare, and Medicaid required.
• Strong knowledge of medical billing, ICD-10, CPT, HCPCS, payer policies, and revenue cycle management.
• Excellent written and verbal communication, organization, stakeholder management, problem-solving, and change-management skills.
• Registered Nurse (RN) preferred; no license or certification is required.

Culture & Benefits

• Remote work is provided at 100% off-site status.
• Work in an innovative, caring, inclusive, diverse, and equitable healthcare environment.
• Collaborate with clinical partners including Boston Children’s Hospital, Beth Israel Deaconess Medical Center, and Brigham and Women’s Hospital.
• No patient contact and no supervisory responsibilities.