Nurse Auditor

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required. Work hours begin between 6:00 AM and 9:00 AM in the associate's home time zone.

Salary: $78,400–$107,800 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare, Medicaid, military, individual, and family customers.

What you will do

• Audit and validate medical record documentation, diagnosis coding, provider codes, and billing for completeness, compliance, accuracy, and appropriate reimbursement.
• Interpret clinical documentation and identify relevant coding, including high-risk CMS Hierarchical Condition Categories.
• Refer appropriate cases for annual follow-up by disease management, case management, and primary care providers.
• Analyze root causes of audit findings and submit recommendations for change management.
• Apply clinical and coding expertise to make independent decisions while following established procedures and organizational objectives.

Requirements

• Active Registered Nurse license in the state of residence.
• At least two consecutive years of acute inpatient hospital experience in a critical or intensive care setting within the last five years, or at least two years of DRG inpatient auditing experience.
• In-depth knowledge of complex medical diagnoses, including sepsis, pneumonia, acidosis, renal failure, encephalopathy, CVA, DKA, and myocardial infarction.
• Advanced knowledge of Microsoft Office, including Word and Excel.
• Strong writing, editing, communication, planning, teamwork, judgment, discretion, and workload-management skills.
• Ability to work remotely from a dedicated, interruption-free space that protects member PHI and HIPAA information.

Nice to have

• Bachelor's degree in a relevant field.
• Inpatient coding certification such as RHIA, RHIT, CCS, CIS, or CIC.
• Inpatient coding claims, prospective payment methodologies, or DRG auditing experience.
• Clinical documentation improvement knowledge or CDE/CDEI certification.

Culture & Benefits

• Fully remote work-from-home arrangement with occasional office travel for training or meetings.
• Monday–Friday schedule, 8 hours per day and 40 hours per week.
• Minimum home internet requirement of 25 Mbps download and 10 Mbps upload.
• Medical, dental, and vision coverage; 401(k); paid time off; company and personal holidays; paid parental and caregiver leave; disability and life insurance.
• Internet expense payments are available for home-based associates in California, Illinois, Montana, or South Dakota.

Hiring process

• Application prescreen followed by a prerecorded voice interview and/or SMS text interview through HireVue.
• Prerecorded interviews typically take 10–15 minutes; SMS interviews typically take 5–10 minutes.