This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional Coder), CIC (Certified Inpatient Coder), CDI (Clinical Documentation Improvement), or a ...
This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional Coder), CIC (Certified Inpatient Coder), CDI (Clinical Documentation Improvement), or a ...
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VA ยท On-site +1
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VA ยท On-site +1
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Virginia Beach, VA ยท On-site +1
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Norfolk, VA ยท On-site +1
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Virginia Beach, VA ยท On-site +1
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Virginia Beach, VA ยท On-site +1
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Staunton, VA ยท On-site +1
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Staunton, VA ยท On-site +1
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VA ยท On-site +1
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VA ยท On-site +1
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Richmond, VA ยท On-site +1
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Newport News, VA ยท On-site +1
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Newport News, VA ยท On-site +1
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Newport News, VA ยท On-site +1
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Newport News, VA ยท On-site +1
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Quick apply
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Manassas, VA ยท On-site +1
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Compact (NLC) license and/or California RN license required, depending on assignment Physical Demand & Work Environment * Fully remote/home-based role * Private, quiet, and secure home office free ...
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RN Field Case Manager
Fredericksburg, VA ยท Remote
$76K - $97K/yr
Must have an RN and prefers 1.5 years of prior workers compensation experience. PRIMARY PURPOSE OF ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Fredericksburg, VA ยท Remote
$76K - $97K/yr
Must have an RN and prefers 1.5 years of prior workers compensation experience. PRIMARY PURPOSE OF ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Fairfax, VA ยท Remote
$79K - $101K/yr
... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...
RN Field Case Manager
Fairfax, VA ยท Remote
$79K - $101K/yr
... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...
RN Field Case Manager
Virginia Beach, VA ยท Remote
$74K - $94K/yr
Must be an RN and prefers 1.5 years of prior workers compensation experience. ARE YOU AN IDEAL ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Virginia Beach, VA ยท Remote
$74K - $94K/yr
Must be an RN and prefers 1.5 years of prior workers compensation experience. ARE YOU AN IDEAL ... remote work environment that allows face to face interaction with injured workers and medical ...
RN Field Case Manager
Fairfax, VA ยท Remote
$79K - $101K/yr
... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...
RN Field Case Manager
Fairfax, VA ยท Remote
$79K - $101K/yr
... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...
Full Time Remote Rn information
What is the highest paying remote nursing job?
What are the key skills and qualifications needed to thrive as a Full Time Remote RN, and why are they important?
What is a Full Time Remote RN?
How to make $300,000 as a nurse online?
What is the difference between Full Time Remote Rn vs Part Time Remote Rn?
| Aspect | Full Time Remote Rn | Part Time Remote Rn |
|---|---|---|
| Work Hours | Typically 35-40 hours per week | Less than 30 hours per week |
| Salary & Benefits | Full benefits, consistent salary | Pro-rated pay, limited benefits |
| Job Responsibilities | Complete full scope of nursing duties | Same duties but with flexible hours |
| Work Environment | Home-based, remote | Home-based, remote |
Full Time Remote Rn roles offer a consistent schedule, full benefits, and a stable income, ideal for those seeking full-time employment. Part Time Remote Rn positions provide flexibility with fewer hours and limited benefits, suitable for individuals balancing other commitments. Both roles allow remote work, but differ mainly in hours and compensation structure.
How to make an extra $2000 a month as a nurse?
How can I make 2000 a week working from home?
How do Full Time Remote RNs typically collaborate with healthcare teams and patients while working from home?
SIU Nurse Auditor, RN, CPC (Full-time, Remote)
Integrity Management Services, Inc.Alexandria, VA โข On-site, Remote
Full-time
Posted 14 days ago
Job description
Job Summary
We are seeking an experienced Clinical Nurse Auditor to join our Payment Integrity team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a Registered Nurse (RN) with coding certifications such as CPC (Certified Professional Coder), CIC (Certified Inpatient Coder), CDI (Clinical Documentation Improvement), or a similar credential, through AAPC or AHIMA. Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential.
How You Will Make an Impact
- Investigations and Audits: Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
- Tool and Policy Development: Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
- Cross-Departmental Collaboration: Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
- Data Analysis and Trending: Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
- Fraud Detection Support: Support fraud investigators with medical review expertise to detect and address fraudulent activities.
- Mentorship: Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.
Requirements
Qualifications
- Education:
- Minimum Associate's Degree in Nursing required;
- Licensure & Certification:
- 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.
- Experience:
- 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.
- Skills:
- 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.
Preferred Traits
- Meticulous, organized, and objective in analyzing claims and documentation.
- Ethical and responsible, with a commitment to supporting the integrity of healthcare billing and reimbursement.
- Able to work independently, stay current with rapidly changing healthcare regulations, and thrive in a fast-paced environment.
About Integrity Management Services
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
51 - 200 Employees
Headquarters location
Alexandria, VA, US
Year founded
2009