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Remote Credentialing Auditor Jobs in Reston, VA (NOW HIRING)

IQVIA

Sr. Clinical QA Auditor

Washington, DC · Remote

$75K - $188K/yr

Plan, conduct, and report onsite and remote audits, ensuring alignment with regulatory requirements ... All information and credentials submitted in your application must be truthful and complete. Any ...

IQVIA

Sr. Clinical QA Auditor

Washington, DC · Remote

$75K - $188K/yr

Plan, conduct, and report onsite and remote audits, ensuring alignment with regulatory requirements ... All information and credentials submitted in your application must be truthful and complete. Any ...

Cooper Thomas

Outpatient Coders

Washington, DC · On-site +1

Remote VA Experienced Outpatient Medical Coders (Full Time & Part Time Positions Available) Summary ... auditing, and training services to the Department of Veterans Affairs (VA), has up to ten (10) ...

Cooper Thomas

Outpatient Coders

Washington, DC · Remote

Remote VA Experienced Outpatient Medical Coders (Full Time & Part Time Positions Available) Summary ... auditing, and training services to the Department of Veterans Affairs (VA), has up to ten (10) ...

Cooper Thomas

Inpatient PTF Coders

Washington, DC · On-site +1

$23.75 - $28.75/hr

VA Experienced Remote Inpatient Facility Fee (PTF) Medical Coders-Full-Time and Part-Time Positions ... auditing, and training services to the Department of Veterans Affairs (VA), has up to eight (8) ...

Cooper Thomas

Inpatient PTF Coders

Washington, DC · Remote

$22.25 - $26.75/hr

VA Experienced Remote Inpatient Facility Fee (PTF) Medical Coders-Full-Time and Part-Time Positions ... auditing, and training services to the Department of Veterans Affairs (VA), has up to eight (8) ...

GPTech

Energy Engineer II

Arlington, VA · On-site +1

This role is currently fully remote; however, a hybrid work arrangement may be required in the ... Certified Energy Manager (CEM) credential through the Association of Energy Engineers (AEE), or ...

Aprio

Senior Accounting Manager

Washington, DC · On-site +1

$115K - $160K/yr

Collaborate with internal and external partners supporting client needs, including auditors, tax ... Bachelor's degree in accounting or equivalent. * CPA or equivalent professional credential ...

Aprio

Senior Accounting Manager

Rockville, MD · On-site +1

$115K - $160K/yr

Collaborate with internal and external partners supporting client needs, including auditors, tax ... Bachelor's degree in accounting or equivalent. * CPA or equivalent professional credential ...

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Remote Credentialing Auditor information

See Reston, VA salary details

$14

$25

$40

How much do remote credentialing auditor jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for remote credentialing auditor in Reston, VA is $25.34, according to ZipRecruiter salary data. Most workers in this role earn between $20.00 and $28.75 per hour, depending on experience, location, and employer.

What is the difference between Remote Credentialing Auditor vs Remote Credentialing Specialist?

AspectRemote Credentialing AuditorRemote Credentialing Specialist
Required credentialsHealthcare-related certifications, compliance knowledgeHealthcare credentials, licensing, and certification knowledge
Work environmentRemote, healthcare or insurance organizationsRemote, healthcare facilities or insurance companies
Employer usageHealthcare providers, insurance companies, credentialing firmsHospitals, clinics, insurance companies, healthcare networks

The Remote Credentialing Auditor primarily reviews and verifies credentials for compliance and accuracy, focusing on auditing processes. In contrast, the Remote Credentialing Specialist manages the credentialing process, ensuring providers meet all licensing and certification requirements. Both roles require healthcare credentials and often work remotely within healthcare or insurance industries, but their core responsibilities differ—auditing versus processing credentialing applications.

What are popular job titles related to Remote Credentialing Auditor jobs in Reston, VA? For Remote Credentialing Auditor jobs in Reston, VA, the most frequently searched job titles are:
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What cities near Reston, VA are hiring for Remote Credentialing Auditor jobs? Cities near Reston, VA with the most Remote Credentialing Auditor job openings:
Remote Credentialing Auditor jobs near you
SIU Nurse Auditor, RN, CPC (Full-time, Remote)

SIU Nurse Auditor, RN, CPC (Full-time, Remote)

Integrity Management Services, Inc.

Alexandria, VA • Remote

Other

Posted 6 days ago

Job description

Job Title: Clinical Nurse Auditor - Payment Integrity

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.

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