RN Clinical Auditor

Location: Remote - Nationwide (United States); travel to and work onsite at client, temporary, or corporate office locations may be required based on business needs.

Salary: $63,100–$108,900 annually, based on experience.

Company

hirify.global provides technology-enabled revenue cycle management and point solutions for hospitals, health systems, and affiliated physician groups across the United States.

What you will do

• Review government, state, and commercial payer clinical audits, DRG clinical validation audits, and related claims.
• Analyze medical records, claims, audit letters, and payer requirements to determine audit findings and appropriate responses.
• Gather, validate, and organize complete medical records and supporting materials from client electronic medical record systems.
• Contact Medicare Administrative Contractors, government agencies, payers, physicians, and insurance plans regarding audit reasons, denials, and documentation requests.
• Analyze trends and discrepancies, report audit findings, and support quality assurance and guideline development.
• Educate coding, clinical documentation, case management, revenue integrity, and other departments on findings and prevention action plans.

Requirements

• Registered Nurse (RN) license.
• Associate or Bachelor’s degree in Nursing.
• Experience with clinical nursing practices, medical records, electronic medical record systems, and healthcare documentation.
• Understanding of medical coding and billing, including DRG, CPT, and ICD-10, as well as Medicare, Medicaid, CMS policies, LCDs, NCDs, and billing articles.
• At least 2 years of regulatory audit, utilization review, clinical validation, denials, or case management experience is strongly preferred.
• Ability to travel to and work onsite at client, temporary, or corporate office locations when business needs require.

Nice to have

• Hospital operations, chart audit or review, and clinical education experience.
• Experience in a production-based work environment and with multiple software tools.
• Openness to using AI and emerging technology to improve processes and patient and client experiences.

Culture & Benefits

• Comprehensive healthcare, time off, retirement, and well-being benefits.
• Paid professional certifications and tuition reimbursement.
• Quarterly and annual incentive programs.
• Work-life flexibility, collaboration, innovation, and professional growth opportunities.