Clinical Nurse Auditor – AI-Driven Claims & Compliance

Visaya Knowledge Process Outsourcing Corporation; Philippines; On-site; PHP 420,000 - 640,000; Full time

Job summary

Visaya Knowledge Process Outsourcing Corporation in Ortigas is seeking a Registered Nurse to join our on-site clinical auditing team, working with AI-assisted review tools to ensure documentation accuracy and compliance. HIPAA familiarity and healthcare regulatory awareness are preferred.

The role audits clinical records and claims for accuracy, validates AI-flagged exceptions, and collaborates with coding and RCM teams to reduce denials and improve cash flow in a fast-paced, compliant

Qualifications

• Registered Nurse with active license.
• Experience in clinical auditing or utilization review.
• Familiarity with HIPAA and healthcare compliance standards.

Responsibilities

• Audit clinical records and claims for accuracy, completeness, and compliance.
• Validate AI-flagged exceptions and document findings.
• Collaborate with coding and RCM teams to reduce denials.

Job description

Visaya Knowledge Process Outsourcing Corporation in Ortigas is seeking a Registered Nurse to join our on-site clinical auditing team, working with AI-assisted review tools to ensure documentation accuracy and compliance. HIPAA familiarity and healthcare regulatory awareness are preferred.

The role audits clinical records and claims for accuracy, validates AI-flagged exceptions, and collaborates with coding and RCM teams to reduce denials and improve cash flow in a fast-paced, compliant