68 rn compliance auditor jobs found

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we...

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe...

CDS Life Transitions seeks a QA Specialist RN Auditor to provide ongoing medical/nursing oversight and direction through internal audit processes in Webster, NY. The position focuses on evaluating program performance, ensuring quality of care, and adherence to agency policy and regulatory requirements. The role involves auditing investigations, supporting programs, updating tools, and reporting trends to management. #J-18808-Ljbffr

Jobtailor is seeking a skilled Registered Nurse in Nashville, TN to lead quality audits and HEDIS/STARS data collection. You will review medical records, analyze clinical data, and present findings to stakeholders to improve care quality and provider compliance. Responsibilities include auditing, process improvement, and coordinating with regional staff. Strong Excel and communication skills are essential for success in this role. #J-18808-Ljbffr

Northwell Health is seeking a Registered Nurse CDI Auditor to validate acute inpatient coded charts and ensure documentation substantiates diagnostic information. This remote position in New York requires a NY RN license, a BSN, and strong knowledge of coding guidelines. You will audit DRG assignments, communicate changes to CDI staff, and ensure compliance with federal and state regulations. #J-18808-Ljbffr

Overview Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states. Position Summary The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team’s broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard reimbursement...

Overview We are seeking a Clinical Coding Auditor & Trainer to lead DRG and medical record auditing and deliver staff training programs. This role supports quality improvement, compliance, and education across clinical and coding teams. Responsibilities Conduct audits of staff work; report findings and improvement recommendations. Develop and deliver coding and DRG training programs. Revise policies and procedures to improve audit accuracy. Maintain training and audit records and track staff progress. Ensure compliance with company policies and healthcare standards. Requirements RN, PA, MD, APRN, DO, or MBBS license. Associate’s degree in Nursing or equivalent experience. 4+ years of DRG and/or medical record audit experience. 1 year of clinical experience in a hospital setting. Preferred Valid/current CPC or CIC Certification (AAPC) or CCS (AHIMA). RHIA/RHIT credentials. Prior training or auditing experience in managed care. Notes Primarily remote position...

Mission Healthcare is hiring a Quality Program Auditor to ensure hospice quality standards and regulatory compliance across branches. You will partner with clinical, education, compliance, and leadership teams to identify improvement opportunities and strengthen outcomes. The role requires an RN with CMS guidance familiarity, strong communication, and ability to operate with limited supervision. Travel to branches will be required, and hybrid work is supported. #J-18808-Ljbffr

Inpatient Coding Auditor (DRG Validation)Pride Health is hiring an Inpatient Coding Auditor (DRG Validation) to support our client's healthcare facility in Oklahoma City, OK. Job Details: Schedule: Monday–Friday (During training 8:00 AM–4:30 PM CST); after training, flexible hours between 6:00 AM–6:00 PM CST. Location: Fully Remote (Oklahoma, Kansas, Missouri, Texas, and Arkansas) Float / Coverage Area: Job Type: Local contract Contract Length: 13 weeks Contract (Possible extension) Pay Range: $43.00 to $46.00/hour* *Pay offered is based on experience, expertise, credentialing, and education. Duties:Perform inpatient coding audits, peer reviews, DRG validation, and quality reviews.Validate principal/secondary diagnoses, procedures, ICD-10-PCS codes, and DRG assignments.Conduct pre-bill reviews, CDI reconciliations, and second-level account reviews.Respond to coding questions and assist with physician queries.Identify coding error trends and recommend workflow improvements.Develop...

Pride Health is hiring an Inpatient Coding Auditor (DRG Validation) to support our client's healthcare facility in Oklahoma City, OK. Job Details: Schedule: Monday-Friday (During training 8:00 AM-4:30 PM CST); after training, flexible hours between 6:00 AM-6:00 PM CST. Location: Fully Remote (Oklahoma, Kansas, Missouri, Texas, and Arkansas) Float / Coverage Area: Job Type: Local contract Contract Length: 13 weeks Contract (Possible extension) Pay Range: $43.00 to $46.00/hour* *Pay offered is based on experience, expertise, credentialing, and education. Duties: Perform inpatient coding audits, peer reviews, DRG validation, and quality reviews. Validate principal/secondary diagnoses, procedures, ICD-10-PCS codes, and DRG assignments. Conduct pre-bill reviews, CDI reconciliations, and second-level account reviews. Respond to coding questions and assist with physician queries. Identify coding error trends and recommend workflow improvements....

Overview Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members and more than 280 sites of care with over 1,800 affiliated providers across six states. POSITION SUMMARY: The Hospital Auditor is responsible for reviewing hospital (inpatient and outpatient) to ensure accuracy, completeness, and compliance with regulatory guidelines and coding standards. This role supports the team's broader mission by identifying documentation gaps, validating coding accuracy, and assessing the effectiveness of hospital practices. Through targeted feedback and education, the Hospital Auditor helps strengthen documentation quality, promote compliant billing, and safeguard reimbursement...

MedStar Health is seeking a Surgical Service Auditor to review clinical documentation in Perioperative and Procedural departments for charging accuracy, regulatory compliance, and quality outcomes. The role partners with service line managers and supply chain to ensure proper pricing and documented charges across the OR and endoscopy suites. The position supports the revenue cycle and requires an associate's degree or related surgical services training, with RN or CST licensure. #J-18808-Ljbffr

Job Description Job Description Pride Health is hiring an Inpatient Coding Auditor (DRG Validation) to support our client's healthcare facility in  Oklahoma City, OK.   Job Details:  Schedule:   Monday–Friday (During training 8:00 AM–4:30 PM CST); after training, flexible hours between 6:00 AM–6:00 PM CST. Location:   Fully Remote (Oklahoma, Kansas, Missouri, Texas, and Arkansas) Float / Coverage Area:  Job Type: Local contract Contract Length: 13 weeks Contract (Possible extension) Pay Range: $43.00 to $46.00/hour* *Pay offered is based on experience, expertise, credentialing, and education.      Duties:  Perform inpatient coding audits, peer reviews, DRG validation, and quality reviews. Validate principal/secondary diagnoses, procedures, ICD-10-PCS codes, and DRG assignments. Conduct pre-bill reviews, CDI reconciliations, and second-level account reviews. Respond to coding questions and assist with physician queries. Identify coding...

We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Think you've got what it takes? Job Duties & Responsibilities • Assess the treatment plan, clinical information, and medical necessity of all requested services • Utilizes established criteria to appropriately review billed services within established timeframe required. • Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate. • Refers case failing medical...

Conducting audits of medical records, the full-time Certified Medical Review Auditor will evaluate the accuracy of medical coding and compliance with health plan policies for Fraud, Waste & Abuse clients while working remotely. Key responsibilities Conduct audits of medical records and healthcare claims to assess coding accuracy and compliance with regulations Prepare and submit detailed reports on audit findings, recommending corrections and process improvements Maintain current knowledge of federal, state, and payer policy and coding guidelines to support review findings Required qualifications Bachelor's Degree in a related discipline or equivalent combination of education and experience Certified Professional Coder (CPC, CCS, CCS-P) credential required 2-5 years of related experience in auditing medical records Preferred licenses: Licensed Practical Nurse (LPN) or Registered Nurse (RN) Proficiency in MS Office suite

To support healthcare audit processes, the remote RN Medical Review Auditor will conduct clinical reviews and Appeals reviews of medical records, ensuring compliance with quality standards while serving as a subject matter expert in the field. Key Responsibilities Conducts clinical reviews and Appeals reviews on medical audit findings, documenting results accurately Analyzes claims data and applies knowledge of relevant guidelines and regulations to validate audit results Identifies training opportunities and contributes to continuous improvement initiatives within the audit process Required Qualifications Active unrestricted RN license in good standing with diversified nursing experience At least 5+ years of relevant SNF/MDS experience in a provider or payer environment Strong technical aptitude with intermediate to advanced Excel skills Experience with ICD-9/ICD-10 coding, HCPS/CPT coding, and medical billing Prior experience in audit, utilization management, or appeals...

Inpatient Coding Auditor (DRG Validation) Pride Health is hiring an Inpatient Coding Auditor (DRG Validation) to support our client's healthcare facility in Oklahoma City, OK. Job Details: Schedule: Monday–Friday (During training 8:00 AM–4:30 PM CST); after training, flexible hours between 6:00 AM–6:00 PM CST. Location: Fully Remote (Oklahoma, Kansas, Missouri, Texas, and Arkansas) Float / Coverage Area: Job Type: Local contract Contract Length: 13 weeks Contract (Possible extension) Pay Range: $43.00 to $46.00/hour* *Pay offered is based on experience, expertise, credentialing, and education. Duties: Perform inpatient coding audits, peer reviews, DRG validation, and quality reviews. Validate principal/secondary diagnoses, procedures, ICD-10-PCS codes, and DRG assignments. Conduct pre-bill reviews, CDI reconciliations, and second-level account reviews. Respond to coding questions and assist with physician queries. Identify coding error trends and recommend workflow...

Under general supervision and in accordance with established policies, procedures, and professional guidelines, the Medical Auditor performs detailed medical record reviews to validate the accuracy of charge capture, hospital billing and ensure compliance with departmental charge policies and regulatory requirements. This role identifies billing discrepancies, documentation gaps, and compliance trends, and recommends corrective actions to departmental leadership when recurring issues are identified. The Medical Auditor represents Tampa General Hospital in matters related to billing, documentation, and reimbursement with third‑party payers, patients, and hospital personnel, while performing all duties in alignment with the mission, vision, and values of Tampa General Hospital. Essential Functions: Conducts comprehensive medical record audits to validate accuracy of hospital billing and compliance with departmental charge policies. Reviews clinical documentation to ensure services...

Position Overview MetroPlusHealth seeks a Clinical Certified Coder to support the Special Investigations Unit in detecting, preventing, and investigating suspected fraud, waste, and abuse. The role reports to the Director of the Special Investigations Unit. Scope of Role & Responsibilities Review medical records and claims to determine accuracy and compliance with regulations. Conduct high‑risk claim audits to detect potential fraud, waste, and abuse. Collaborate with the SIU team to evaluate suspected fraudulent activities such as over‑utilization, upcoding, and non‑medically necessary services. Create detailed reports with findings, rationale, sources, and corrective action recommendations. Assist in provider calls to discuss findings and rationale. Present findings to leadership and stakeholders to facilitate FWA proceedings. Prepare documentation for audits, recoupments, compliance/legal reviews, and regulatory inquiries. Maintain thorough documentation of...

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its...

Northwell Health is seeking a Registered Nurse CDI Auditor to validate acute inpatient coded charts and ensure documentation substantiates diagnostic information. This remote position in New York requires a NY RN license, a BSN, and strong knowledge of coding guidelines. You will audit DRG assignments, communicate changes to CDI staff, and ensure compliance with federal and state regulations. #J-18808-Ljbffr

Northwell Health is seeking a Registered Nurse CDI Auditor to validate acute inpatient coded charts and ensure documentation substantiates diagnostic information. This remote position in New York requires a NY RN license, a BSN, and strong knowledge of coding guidelines. You will audit DRG assignments, communicate changes to CDI staff, and ensure compliance with federal and state regulations. #J-18808-Ljbffr

Job Description - Medical Auditor - Medical Bill Audit (260003BX) Job Description Medical Auditor - Medical Bill Audit - ( 260003BX ) Description Under general supervision and in accordance with established policies, procedures, and professional guidelines, the Medical Auditor performs detailed medical record reviews to validate the accuracy of charge capture, hospital billing and ensure compliance with departmental charge policies and regulatory requirements. This role identifies billing discrepancies, documentation gaps, and compliance trends, and recommends corrective actions to departmental leadership when recurring issues are identified. The Medical Auditor represents Tampa General Hospital in matters related to billing, documentation, and reimbursement with third-party payers, patients, and hospital personnel, while performing all duties in alignment with the mission, vision, and values of Tampa General Hospital. Essential Functions Conducts comprehensive medical record...

Blue Cross & Blue Shield of Mississippi is seeking a Senior Clinical Compliance Auditor to act as the primary clinical reviewer of findings, complaints, and appeals related to care provided by network hospitals, providers and pharmacies. You will assess billing and coding accuracy, ensure compliance, and prepare objective audit reports. The ideal candidate has a nursing degree, an active Mississippi RN license, 3+ years of clinical healthcare experience, and strong knowledge of CPT/HCPCS/ICD-10 #J-18808-Ljbffr