[Hiring] Registered Nurse Clinical Auditor @RADcube - A NLogix Company

Role Description

We are seeking a detail-oriented Registered Nurse to support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs. This role is responsible for:

• Evaluating the quality of care
• Reviewing medical records and program policies
• Identifying compliance issues
• Preparing audit documentation and reports
• Supporting appeals activities

The ideal candidate brings clinical knowledge, regulatory awareness, and strong analytical and writing skills. This is a remote position with occasional travel required within Indiana.

Qualifications

• RN license preferred; Indiana license or compact license accepted
• Coding certification such as CCS or CPC strongly preferred
• Candidate located in or near the Indianapolis area is 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

Requirements

• 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