Clinical Medical Audit Supervisor (Remote)

Machinify; Northern (KY); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Machinify seeks a Medical Review Audit Supervisor - Clinical to lead a remote team of nurses and audit staff, applying their clinical review expertise to drive consistency, quality, and efficiency in claims auditing.

The role includes staff supervision, capacity planning, QA reviews, and collaboration with multiple departments to meet SLAs and regulatory requirements while ensuring adherence to CMS, Medicaid, and payer guidelines.

Qualifications

• Current active unrestricted Nursing license.
• Medical coding certification is a plus.
• 3+ years diverse nursing experience providing direct care.
• 2+ years performing medical record audits.
• 5+ years in health care claims with ICD coding and billing.
• 3+ years supervisory or leadership experience; remote staff a plus.
• Experience with payer update/edit and reimbursement policy is beneficial.

Responsibilities

• Regularly performs limited volume of clinical audits to maintain subject matter expertise.
• Performs audit quality assurance reviews and supports QA activity.
• Supervises daily activities of clinical audit staff and provides guidance.
• Provides production and quality performance reports, coaching and feedback.
• Leads staffing and capacity planning, ensuring SLAs are met.
• Collaborates with other departments to resolve operational problems.
• Monitors inventory and resource planning for audits and staff.
• Ensures adherence to medical review guidelines and training requirements.

Skills

Nursing license

Supervisory experience

Leadership

Communication skills

Remote team management

Analytical skills

Education

Nursing degree / RN license

Medical coding certification

Tools

MS Office

Case management systems

Clinical decision-support tools

Job description

Machinify seeks a Medical Review Audit Supervisor - Clinical to lead a remote team of nurses and audit staff, applying their clinical review expertise to drive consistency, quality, and efficiency in claims auditing.

The role includes staff supervision, capacity planning, QA reviews, and collaboration with multiple departments to meet SLAs and regulatory requirements while ensuring adherence to CMS, Medicaid, and payer guidelines.