Nurse Auditor, HCC Program Mgmt – Medicare Reimbursement

Presbyterian Healthcare Services; Albuquerque (NM); On-site; USD 67,100 - 102,460; Full time

Benefits offered by this job

Tuition reimbursement

Malpractice liability insurance

Wellness program access

Job summary

A healthcare organization is seeking an RN - Nurse Auditor to perform clinical audits and validate medical documentation for Medicare services in Albuquerque, NM. Candidates should possess a New Mexico nursing license and preferably have experience in medical claims review. This full-time role emphasizes teamwork, analytical skills, and compliance with healthcare regulations. Competitive compensation with benefits including tuition reimbursement and a wellness program is offered.

Qualifications

• Licensure: Valid New Mexico Nursing license (RN).
• Certifications preferred: Certified Medical Audit Specialist, Certified Risk Adjustment Coder, Certified Professional Coder.
• Three years preferred experience in medical claims review.

Responsibilities

• Perform clinical audit processes for Medicare documentation accuracy.
• Validate medical documentation for Medicare Risk Adjustment.
• Identify cases for follow-up care by relevant providers.

Skills

Strong analytical skills

Excellent communication skills

Teamwork ability

Proficiency in Microsoft Office

Education

New Mexico Nursing license (RN)

Associate Degree or graduate of practical nursing program

Tools

EPIC electronic charting system

Job description

A healthcare organization is seeking an RN - Nurse Auditor to perform clinical audits and validate medical documentation for Medicare services in Albuquerque, NM. Candidates should possess a New Mexico nursing license and preferably have experience in medical claims review. This full-time role emphasizes teamwork, analytical skills, and compliance with healthcare regulations. Competitive compensation with benefits including tuition reimbursement and a wellness program is offered.