Remote Nurse Compliance & Audit Strategist

Career at Callmax Solutions - Philippines; Metro Manila; On-site; PHP 360,000 - 600,000; Full time

Job summary

Callmax Solutions - Philippines in Metro Manila is seeking a detail-oriented Nurse Auditor to audit medical records and ensure compliant billing practices. The role requires an active PH RN license and strong clinical auditing experience, including MDS/quality measures and familiarity with EHR systems.

The successful candidate will review physician documentation, identify discrepancies, and prepare actionable reports while coordinating with care teams to uphold regulatory standards and improve

Qualifications

• Active PH Registered Nurse license.
• Extensive clinical knowledge and experience for auditing medical records.
• Proficiency with medical billing software and EHR systems.
• Experience in MDS and quality measures in nursing homes.
• Knowledge of healthcare regulations and laws for compliance.
• Coding background is a plus.
• Excellent written and verbal communication for reporting findings and coordinating with departments.
• Strong analytical and critical thinking to interpret data and medical records.

Responsibilities

• Compile lists of nursing home patients requiring doctor visits based on vital signs and indicators.
• CPT Code Auditing: analyze weekly provider notes for accurate billing practices.
• Hospitalization Report Management: audit and investigate patient hospitalizations and provide updates from clinical notes.
• Occasional Invoice Auditing: compare coded notes with billing records to identify discrepancies.
• Regular audits of nursing documentation to ensure compliance with policies and regulations.
• Evaluate compliance with healthcare guidelines such as Medicare/Medicaid and accreditation standards.
• Analyze audit findings and prepare reports highlighting improvements, trends, and gaps.

Skills

PH RN license

Clinical auditing

EHR systems

MDS & quality measures

Healthcare regulations

Medical coding

Communication skills

Analytical thinking

Job description

Callmax Solutions - Philippines in Metro Manila is seeking a detail-oriented Nurse Auditor to audit medical records and ensure compliant billing practices. The role requires an active PH RN license and strong clinical auditing experience, including MDS/quality measures and familiarity with EHR systems.

The successful candidate will review physician documentation, identify discrepancies, and prepare actionable reports while coordinating with care teams to uphold regulatory standards and improve