Clinical Nurse Coding Auditor

🕒 May 13

⚔️ Virginia – Remote

⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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Integrity Management Services, Inc.

WebsiteLinkedInAll Job Openings

51 - 200 employees

📋 Compliance

🏛️ Government

🎯 Recruiter

Compliance • Government • Recruitment

Integrity Management Services, Inc. is a women-owned, women-run company specializing in helping government and commercial enterprises minimize the risk of improper payments, fraud, waste, and abuse. The company provides a range of services including data analytics, fraud investigations, compliance reviews, audits, grants management, staff augmentation, and coding and medical reviews. IntegrityM, as they are known, works closely with Federal Government agencies, state agencies, and private sector organizations to drive informed decisions and enhance program transparency and oversight. The company is recognized for its contributions to the community and has been awarded for excellence in government contracting and corporate social responsibility.

📋 Description

• Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities. • Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity. • Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed. • Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy. • Support fraud investigators with medical review expertise to detect and address fraudulent activities. • Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.

🎯 Requirements

• Minimum **Associate’s Degree in Nursing** required; • Current, unrestricted **Registered Nurse (RN)** license in applicable state(s). • Certification in medical coding from **AAPC** or **AHIMA** (e.g., CPC, CIC, CDI, or equivalent) is highly preferred. • Minimum **5 years of clinical nursing experience**, preferably with exposure to hospital bill auditing or defense auditing. • Strong knowledge of **provider manuals**, **reimbursement policies**, and **medical policy guidelines**. • Prior experience with **healthcare fraud investigation** and auditing is highly preferred. • Proficiency in CPT/HCPCS and ICD-10 coding, with a strong foundation in auditing, accounting, and control principles. • Analytical and problem-solving skills with a keen attention to detail. • Exceptional written and verbal communication skills for clear and effective reporting and provider engagement. • Strong proficiency in Microsoft Office and familiarity with audit tracking systems.