Remote RN Compliance Auditor for Health Services

Trillium Health Resources; Raleigh (NC); Remote; USD 69,000 - 92,000; Full time

Benefits offered by this job

Health Insurance

Flexible Spending Accounts

PTO 24 days

Paid holidays 12

Pension with 5% match

PSLF eligible employer

Remote work stipend

Job summary

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role requires an Associate's degree in Nursing, NC RN licensure, valid driver’s license, NC residency, and the ability to travel within the catchment; remote NC work is supported.

Daily tasks include reviewing pre- and post-payment claims, auditing documentation against policies, directing corrective actions, and

Qualifications

• Associate's degree in Nursing and one year of experience in physical health or behavioral health, mental health, substance use, developmental disabilities, and/or co-occurring disorders populations or field.
• Active North Carolina Licensure as a Registered Nurse (RN).
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

Responsibilities

• Conduct clinical reviews of pre- and post-payment claims to verify compliance.
• Evaluate clinical documentation against coverage policies and service definitions.
• Apply independent clinical judgment to determine compliance and identify discrepancies.
• Manage assigned compliance cases from intake through resolution.
• Investigate allegations of non-compliance.
• Evaluate case findings and determine appropriate corrective actions.
• Maintain complete case files in accordance with regulatory and accreditation standards.

Job description

Trillium Health Resources is seeking a Compliance Nurse to perform clinical compliance reviews and evaluate claims to ensure adherence to regulatory and coverage requirements. The role requires an Associate's degree in Nursing, NC RN licensure, valid driver’s license, NC residency, and the ability to travel within the catchment; remote NC work is supported.

Daily tasks include reviewing pre- and post-payment claims, auditing documentation against policies, directing corrective actions, and