Medical Review Nurse - CMS/RAC Auditor, Government Audits (Fully Remote)

Machinify; United States; Remote; USD 70,000 - 98,000; Full time

Job summary

Machinify, a healthcare intelligence company providing AI-powered payment solutions for health plans, is seeking a remote Medical Auditor and Coder. You will join an experienced team auditing government payer claims and documenting findings while collaborating across locations.

The role requires an active RN license, five years of nursing experience, and strong ICD-10, CPT/HCPCS, DRG billing knowledge; RAC certification is a plus.

Qualifications

• Must hold an active RN license and have five years of nursing experience.
• Experience with ICD-10, CPT/HCPCS, and DRG billing required; RAC certification preferred.

Responsibilities

• Audit claims for medical appropriateness and document findings.
• Draft appeal letters and collaborate to improve policies and workflows.

Skills

Medical auditing

Medical coding

Appeals drafting

Education

RN license

5 years nursing experience

Tools

ICD-10

CPT/HCPCS

DRG billing

RAC certification

Job description

• Join a team of experienced medical auditors and coders performing audits for government payers.
• Work remotely in a fast-paced, dynamic, multi-location team.

Responsibilities:

• Audit claims for medical appropriateness and document findings.
• Draft appeal letters and collaborate to improve policies and workflows.

Qualifications:

• Active RN license and five years of nursing experience required.
• ICD-10, CPT/HCPCS, and DRG billing experience required; RAC certification preferred.

Machinify

Machinify is a healthcare intelligence company providing AI-powered payment solutions for health plans. It serves over 85 health plans and more than 270 million lives, with a culture focused on innovation and reducing healthcare costs.