Registered Nurse; RN Clinical Auditor
Position: Registered Nurse (RN) Clinical Auditor | 250795 We are seeking a clinically sharp Registered Nurse with a strong hospital background to join our Revenue Integrity team. This role is a strategic "clinical detective" position where you will audit patient charts to ensure clinical documentation accurately reflects the high-level care provided. This is an excellent career pivot opportunity for hospital nurses looking to transition into CDI and Clinical Audit. Salary Range: $95,000.00 - $110,000+ (potential for higher based on experience/requirements) Schedule: Work from home 3 days a week; 2 days in the Garden City office.
Key Responsibilities
- Chart Auditing: Conduct comprehensive reviews of medical records to ensure all services provided are accurately documented and billed.
- Denials Management: Prepare clinical appeals and responses to insurance denials by utilizing evidence-based clinical rationales.
- Revenue Integrity: Reconcile patient charts with final bills to ensure compliance with CPT/HCPCS coding and Charge Description Masters.
- Clinical Liaison: Partner with HIM and ancillary departments to identify trends in documentation gaps and suggest process improvements.
- Compliance Reporting: Coordinate with Medicare/Commercial audit programs to ensure all regulatory timelines and reporting standards are met.
Requirements
- Education: Associate or Bachelor of Science in Nursing (BSN) required.
- Licensure: Active New York Registered Nurse (RN) license.
- Clinical
Experience: Experience in a CDI role or 3+ years of experience in an Acute Care/Hospital setting (ICU, ER, Med‑Surg) is highly preferred.
- Analytical
Skills: Strong ability to understand insurance terms (HMO/PPO, EOB, stop loss) and hospital payment methodologies.
- Tech Savvy: Proficiency in EMR systems, spreadsheets, and remote‑work software; must have a dedicated, secure home workspace with high-speed internet.
Why Apply? ✓ Career Pivot: Gain specialized training in CDI, Revenue Integrity, and Clinical Auditing. ✓ Hybrid Flexibility: Enjoy a blend of onsite collaboration and remote work. ✓ Professional Impact: Move from the bedside to a role where your clinical expertise drives hospital-wide compliance and financial health. #J-18808-Ljbffr Apply tot his job Apply To this Job