Remote RN Auditor and Nurse Coder - Payment Integrity

Medix™; United States; Teletrabalho; USD 70 000 - 95 000; Tempo integral

Resumo da oferta

Medix is seeking an experienced Clinical Nurse Auditor / RN Nurse Coder (Payment Integrity) for a remote, full-time role. You will analyze flagged claims, validate diagnoses, and determine claim validity to protect resources and ensure accurate reimbursement.

Responsibilities include clinical review of inpatient and outpatient claims, identifying upcoding and billing discrepancies, and using our audit platform to document findings and route claims for review.

Qualificações

• Active RN license in practice state.
• 2-3+ years clinical nursing experience, inpatient preferred.
• 1-2+ years medical coding or payment integrity experience.
• Experience with ICD-10-CM/PCS, CPT/HCPCS, MS-DRG, and APR-DRG.

Responsabilidades

• Review flagged claims for clinical validity and request docs.
• Identify improper coding and upcoding trends.
• Process pre-flagged claim batches with audit indicators.
• Evaluate facility and professional billing, focusing on high-cost inpatient cases.
• Document findings in audit platform and route claims accordingly.

Conhecimentos

RN license

Clinical nursing

Medical coding

Analytical thinking

Clinical decision-making

EHR proficiency

Auditing knowledge

Billing rules

Ferramentas

EHR systems

Audit software

Claims platform

Descrição da oferta de emprego

Medix is seeking an experienced Clinical Nurse Auditor / RN Nurse Coder (Payment Integrity) for a remote, full-time role. You will analyze flagged claims, validate diagnoses, and determine claim validity to protect resources and ensure accurate reimbursement.

Responsibilities include clinical review of inpatient and outpatient claims, identifying upcoding and billing discrepancies, and using our audit platform to document findings and route claims for review.