Remote RN Medical Appeals Auditor

The Rawlings Group; United States; On-site; USD 80,000 - 110,000; Full time

Job summary

Machinify is seeking a Medical Review Clinical Appeals Auditor (RN) to conduct Appeals reviews of new evidence and document results with precision. The role requires an RN license and 5+ years of SNF/MDS auditing experience, with strong communication skills and proficiency in Excel.

Remote work is strongly preferred; candidates should be able to collaborate with cross-functional teams, manage multiple audits, and stay current with industry guidelines and CMS rules.

Qualifications

• Active unrestricted RN license in good standing.
• 5+ years SNF/MDS auditing experience.
• Experience with CPT/HCPCS/ICD-9/ICD-10 coding may be necessary.
• Strong communication skills and ability to work independently.
• Experience with Excel and reporting tools.

Responsibilities

• Performs clinical reviews on medical records to maintain subject matter expertise.
• Conducts Appeals reviews on medical review audit work with new evidence.
• Documents Appeals results accurately per quality policies and routes results in audit platform.
• Reviews audit documentation and analyzes claims data to determine audit accuracy.
• Provides corrections to narrative rationale and flags patterns for leadership intervention.
• Supports training material/tools development and continuous improvement.

Skills

RN license

Communication skills

Self-starter

Independent work

Time management

Analytical skills

Education

RN license

Tools

Excel

MS Office

Job description

Machinify is seeking a Medical Review Clinical Appeals Auditor (RN) to conduct Appeals reviews of new evidence and document results with precision. The role requires an RN license and 5+ years of SNF/MDS auditing experience, with strong communication skills and proficiency in Excel.

Remote work is strongly preferred; candidates should be able to collaborate with cross-functional teams, manage multiple audits, and stay current with industry guidelines and CMS rules.