RN Clinical Auditor (43914)

The RN Clinical Auditor is responsible for conducting comprehensive reviews of claim data and medical record documentation to detect and prevent fraud, waste, and abuse in healthcare services. The role requires a registered nurse with an active license in RI, 3+ years of experience in healthcare coding, and knowledge of medical terminology and regulations.

Requirements

• Registered Nurse with an active, current, unrestricted license in RI in good standing
• Minimum of three (3) years experience in healthcare coding directly related to determining appropriate diagnosis, procedure and other codes used in billing for services, utilization management, medical record auditing, or health care quality improvement
• Knowledge of clinical medical record documentation requirements
• A high-level knowledge of medical terminology
• Proficient with various technology software tools, including Microsoft Office
• Excellent written and verbal communication skills, and strong attention to detail
• Ability to maintain confidentiality
• Ability to take direction and support a multitude of individuals
• Ability to work independently and prioritize activities