Registered Nurse, Clinical Auditor

🕒 May 5

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RADcube

WebsiteLinkedInAll Job Openings

201 - 500 employees

🤖 Artificial Intelligence

🏢 Enterprise

🔒 Cybersecurity

Artificial Intelligence • Enterprise • Cybersecurity

<RADcube> is a global technology and systems integration partner that designs and delivers production-ready AI platforms through RADlabs, focusing on governed, secure, and enterprise-scale solutions. The company builds governed AI and agentic systems, intelligent document processing (HIPAA-aware), data engineering and analytics, cloud & DevOps, cybersecurity & GRC, and process automation to modernize systems, operationalize AI, and scale innovation with an emphasis on security, compliance, and Responsible AI. RADcube serves multiple industries including government, health & life sciences, banking & finance, e-commerce, manufacturing, transportation & logistics, and education.

📋 Description

• Review medical records and related documentation to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations. • Conduct medical record and compliance reviews independently and provide preliminary findings to the Lead Reviewer. • Identify potential documentation deficiencies, and billing compliance issues. • Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached. • Assist with audit responses and appeals as needed. • Ensure all work aligns with state, federal, and national healthcare and Medicaid guidelines. • Stay current on clinical guidelines, policies, regulations, and Indiana Medicaid program and policy updates. • Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures. • Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.

🎯 Requirements

• RN license preferred; Indiana license or compact license accepted. • Coding certification such as CCS or CPC strongly preferred. • At least 1 year of Medicaid claims review, billing compliance, or healthcare reimbursement experience. • Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred. • Knowledge of CPT coding guidelines and ICD-10 standards. • Proficiency in Microsoft Excel, Word, and Outlook. • Strong analytical, critical thinking, problem-solving, and technical writing skills. • Ability to work independently and collaboratively in a fast-paced environment. • Experience working with healthcare providers is strongly preferred. • Knowledge of healthcare claims data and fraud, waste, and abuse preferred.

🏖️ Benefits

• Wellness programs • Professional development opportunities