Registered Nurse; RN Clinical Auditor

Position: Registered Nurse (RN) Clinical Auditor | 250795

We are seeking a clinically sharp Registered Nurse with a strong hospital background to join our Revenue Integrity team. This role is a strategic "clinical detective" position where you will audit patient charts to ensure clinical documentation accurately reflects the high-level care provided.

This is an excellent career pivot opportunity for hospital nurses looking to transition into CDI and Clinical Audit.

Salary Range: $95,000.00 - $110,000+ (potential for higher based on experience/requirements)

Schedule: Work from home 3 days a week; 2 days in the Garden City office.
Key Responsibilities
• Chart Auditing: Conduct comprehensive reviews of medical records to ensure all services provided are accurately documented and billed.
• Denials Management: Prepare clinical appeals and responses to insurance denials by utilizing evidence-based clinical rationales.
• Revenue Integrity: Reconcile patient charts with final bills to ensure compliance with CPT/HCPCS coding and Charge Description Masters.
• Clinical Liaison: Partner with HIM and ancillary departments to identify trends in documentation gaps and suggest process improvements.
• Compliance Reporting: Coordinate with Medicare/Commercial audit programs to ensure all regulatory timelines and reporting standards are met.
Requirements
• Education: Associate or Bachelor of Science in Nursing (BSN) required.
• Licensure: Active New York Registered Nurse (RN) license.
• Clinical

Experience:

Experience in a CDI role or 3+ years of experience in an Acute Care/Hospital setting (ICU, ER, Med‑Surg) is highly preferred.
• Analytical

Skills:

Strong ability to understand insurance terms (HMO/PPO, EOB, stop loss) and hospital payment methodologies.
• Tech Savvy: Proficiency in EMR systems, spreadsheets, and remote‑work software; must have a dedicated, secure home workspace with high-speed internet.
Why Apply?

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Career Pivot: Gain specialized training in CDI, Revenue Integrity, and Clinical Auditing.

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Hybrid Flexibility: Enjoy a blend of onsite collaboration and remote work.

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Professional Impact: Move from the bedside to a role where your clinical expertise drives hospital-wide compliance and financial health.
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