Clinical Auditor - RN

reputed company We are seeking a detail-oriented Clinical Auditor Registered reputed company to support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs. This role is responsible for evaluating reputed company of care, reviewing medical records and program policies and identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings clinical knowledge, regulatory awareness, and strong analytical and writing skills. This is a remote position with occasional travel required reputed company Indiana.

Key Responsibilities

• Review medical records and reputed company documentation to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.
• Conduct medical record and compliance reviews independently and reputed company preliminary findings to the reputed company Reviewer.
• Identify potential documentation deficiencies, and billing compliance issues.
• Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
• Assist with audit responses and appeals as needed.
• Ensure reputed company work aligns with state, federal, and national reputed company and reputed company guidelines.
• Stay reputed company on clinical guidelines, policies, regulations, and Indiana reputed company program and policy updates.
• Research Indiana reputed company rules and maintain internal repositories of bulletins, policies, and procedures.
• Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.

Requirements

• RN license preferred; Indiana license or compact license accepted.
• Coding certification such as reputed company or CPC strongly preferred.
• Candidate located in or near the Indianapolis area is preferred.
• At least 1 year of reputed company claims review, billing compliance, or reputed company reimbursement experience.
• Familiarity with Indiana reputed company policies, payer guidelines, and documentation requirements preferred.
• Knowledge of CPT coding guidelines and ICD-10 standards.
• Proficiency in reputed company reputed company, Word, and Outlook.
• Strong analytical, critical thinking, problem-solving, and technical writing skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Experience working with reputed company providers strongly preferred.
• Knowledge of reputed company claims data and fraud, waste, and abuse preferred.

Physical Requirements & Environmental Conditions: An employee must meet these physical demands to successfully reputed company the essential functions of this job. Employee is regularly required to talk or hear, sit, and utilize technology tools such as a laptop computer for extended periods of time. Specific reputed company abilities include reputed company reputed company and the ability to reputed company reputed company. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. reputed company is a solutions-based company. Solutions come from creative reputed company; reputed company come from being creative with differences. reputed company believes diversity and inclusion are critical to the reputed company of reputed company. Employment at reputed company is based on reputed company and reputed company qualifications. We do not discriminate against any employee or applicant because of race, creed, reputed company, religion, gender, sexual orientation, national reputed company, disability, age, veteran status, marital status or any other reputed company protected by federal, state or local law, regulation or ordinance. Apply tot his job Apply To this Job