Nurse Auditor Coder – RN with CRC or CIC – Weekdays (100% Remote)

Nurse Auditor Coder (RN + CRC or CIC) | Clinical Claim Review | Weekdays | 100% Remote

100% Remote, U.S.-based  |  1099 Independent Contractor  |  Monday–Friday  |  Minimum 15 hours per week

Before applying, please confirm that you meet all three requirements below. Applications that do not meet each of them will not be considered.

1. An active, unencumbered RN license in the United States.
2. An active CRC (Certified Risk Adjustment Coder) or CIC (Certified Inpatient Coder) credential in good standing.
3. Availability for at least 15 hours per week, Monday through Friday, between 8:00 am and 8:00 pm Eastern, scheduled in blocks of at least four hours.

About MHMDAA

Michael Hill, MD and Associates (MHMDAA) is a clinical consulting firm specializing in expert witness opinions for payer–provider claim disputes. Law firms and insurers rely on Dr. Michael Hill and our clinical team for defensible opinions on medical necessity, coding and billing accuracy, regulatory compliance, and claims-handling practices.

Our team of contracted nurses, physicians, coders, and operations staff is supported by a technical and abstraction team. Our work product, the Claim Review (CR) report, ranges from ten pages to several hundred and is built from primary source medical records, payer policy, and regulatory guidance. The Nurse Auditor is the clinical checkpoint that makes those reports defensible.

Position Summary

The Nurse Auditor Coder performs the clinical and coding validation pass on draft Claim Review reports before they advance to physician and client review. Draft reports are assembled by our production team using standardized templates, scenario libraries, and AI-assisted abstraction. The auditor independently verifies each draft against the primary source medical record, confirms that every clinical statement, date, code, dollar amount, and citation is accurate and supported, and supplies the clinical judgment that automated abstraction and non-clinical staff cannot. Comfort with AI-assisted tools and evolving processes is required.

Core Responsibilities

Clinical and coding validation

• Audit assigned draft CR reports section by section against the primary source medical record: demographics, dispute issue, clinical course summary, payer methodology, documentation, and conclusion.
• Verify every clinical assertion against the underlying record. AI-assisted abstraction is a starting point, not a source; the auditor is responsible for identifying omissions and consolidations.
• Validate ICD-10-CM, CPT/HCPCS, and DRG assignments against the documentation and applicable coding guidelines.
• Apply the scenario-specific audit checklist for each case type, including ED level downgrades, inpatient medical necessity, two-midnight determinations, DRG validation, non-covered or self-administered drug denials, and risk adjustment (HCC) diagnosis validation.
• Evaluate the payer's own policy and criteria as applied to the case, and flag determinations that do not hold up against the payer's published methodology.
• Escalate ambiguous, non-standard, or systemic findings to leadership.

Collaboration and continuous improvement

• Participate in daily case review calls and contribute observations that improve checklists, templates, and standard language.
• Work alongside physicians, coders, and the technical team, and provide the clinical perspective in tool and workflow design.
• Adapt quickly as templates, checklists, and the audit platform evolve. This role is not suited to contractors who require a fixed, unchanging process.
• Work independently in a remote environment, including troubleshooting routine technical issues.

Required Qualifications

• Active, unencumbered RN license in the United States.
• Active CRC (Certified Risk Adjustment Coder) or CIC (Certified Inpatient Coder) credential in good standing. Applications without a current CRC or CIC will not be considered.
• Bachelor's degree required; BSN preferred.
• Minimum of five years of experience in one or more of the following: utilization review or management, medical coding, chart or claims auditing, payment or revenue integrity, clinical validation, or denials and appeals.
• Hands-on experience applying MCG or InterQual criteria.
• Retrospective chart review and abstraction experience across large, unstructured medical record sets.
• Working knowledge of the ICD-10-CM Official Guidelines for Coding and Reporting, the CMS-HCC risk adjustment model, CPT/HCPCS coding conventions, and Medicare and Medicaid coverage and regulatory guidance.
• Strong professional writing: the ability to summarize a clinical course accurately and concisely, in a form that will withstand opposing review.
• Proficiency in Microsoft Word, Excel, Teams, and SharePoint, and in Adobe Acrobat Pro across large PDF sets.
• Willingness to work with AI-assisted tools while independently validating their output.
• Availability of at least 15 hours per week, Monday–Friday, within the 8:00 am – 8:00 pm Eastern window, in blocks of at least four hours.
• A private, HIPAA-compliant home workspace and reliable high-speed internet.

Preferred Qualifications

• Both CRC and CIC, or an additional credential such as CPC, CCS, CPMA, or CDIP.
• Experience with both MCG and InterQual.
• DRG validation and inpatient coding experience.
• CMS-HCC risk adjustment chart review or RADV audit experience.
• Emergency department E/M leveling and downcoding experience.
• Prior expert witness, litigation support, or legal claim dispute experience.
• Experience working with distributed and international teams across time zones.

Schedule and Availability

• Days: Monday through Friday (weekday coverage).
• Minimum commitment: 15 hours per week, with additional hours available based on case volume.
• Hours: Self-scheduled within an 8:00 am – 8:00 pm Eastern window, in blocks of at least four consecutive hours on each day you declare availability. Daytime blocks, evening blocks, or a combination may be used after orientation.
• Availability tracker: Contractors post weekly availability to a shared tracker and are expected to be at their computer, responsive, and actively working during declared hours.
• Team calls: Case review calls are held daily via Microsoft Teams at 9:00 am, 1:00 pm, 4:00 pm, and 8:00 pm Eastern. Contractors attend the calls that fall within their working hours, attend ad hoc meetings scheduled during their shifts, and escalate questions promptly between calls.
• Orientation: Availability is required for five consecutive business days (Monday–Friday), 9:00 am – 5:00 pm Eastern, to accommodate preceptor availability.
• Additional hours: Weekend work is sometimes available after training, subject to case flow. Volume is project-based and may slow around holidays. Hours and assignments depend on client contracts and are not guaranteed.

Engagement Terms

• Classification: 1099 independent contractor. No benefits.
• Compensation: Hourly; rate based on experience and credentials. Invoiced monthly.
• Location: 100% remote within the United States.
• Equipment: Contractors provide their own computer, high-speed internet, and private, HIPAA-compliant home workspace. MHMDAA provides required software licenses and platform access.
• Time off during onboarding: Any planned time off exceeding five consecutive days during the first 30 days of the engagement must be disclosed and approved before the contract is executed.

How to Apply

Send your resume to resumes@mhmdaa.com with "Nurse Auditor Coder CRC/CIC – Weekdays" in the subject line. Please list your RN license state(s) and your coding credential(s) with credential numbers on your resume.