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Remote Rn Auditor Jobs in Columbia, SC (NOW HIRING)

CVS Health

Case Manager, Registered Nurse

Columbia, SC · Remote

$54K - $155K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... A RN who resides in a compact state is required to have an active multistate license through the ...

DataAnnotation

RN

Columbia, SC · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

Amerihealth Caritas

Care Manager II

Columbia, SC · Remote

Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...

BOTG LLC

Medical Coder Reviewer

Columbia, SC · Remote

$15.25 - $20.50/hr

Medical Coder/Reviewer Duration: 12 Months (With possible extension) Location: 100% Remote ... a Registered Nurse. Currently credentialed as CPC (Certified Professional Coder) or as CCS ...

Amerihealth Caritas

Care Manager II

Columbia, SC · Remote

Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...

Amerihealth Caritas

Care Manager II

Columbia, SC · Remote

Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...

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All JobsRemote Rn Auditor JobsRemote Rn Auditor Jobs in Columbia, SC

Remote Rn Auditor information

See Columbia, SC salary details

$18

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$43

How much do remote rn auditor jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for remote rn auditor in Columbia, SC is $30.52, according to ZipRecruiter salary data. Most workers in this role earn between $26.68 and $33.37 per hour, depending on experience, location, and employer.

What is the difference between Remote Rn Auditor vs Remote Rn Reviewer?

AspectRemote Rn AuditorRemote Rn Reviewer
CertificationsRN license, auditing certifications (e.g., CHAP, RAC)RN license, clinical review certifications
Work EnvironmentHealthcare organizations, insurance companies, auditing firmsHealthcare providers, insurance companies, utilization review
Primary ResponsibilitiesAuditing medical records for compliance, coding accuracy, and billingReviewing medical records for appropriateness and medical necessity

Remote Rn Auditors focus on compliance and coding accuracy through audits, while Remote Rn Reviewers primarily assess medical necessity and appropriateness of care. Both roles require RN licensure and related certifications, often working within healthcare or insurance settings. The key difference lies in their core functions: auditing versus clinical review, though both contribute to quality and compliance in healthcare reimbursement.

What Does a Remote RN Auditor Do?

As a remote RN auditor, your job is to review claims and audit financial statements to ensure validity and accuracy. In this role, you may examine documentation from the patient or clinic, evaluate the effectiveness of care, or ensure that claims comply with government regulations. RN auditors often provide advice for cutting costs and contact both healthcare providers and clients to negotiate specific claims or resolve billing issues. Remote RN auditors often work with daily or weekly batches of work as assigned, but in rare cases, you may be asked to prioritize auditing certain material when time is of the essence.

What are the key skills and qualifications needed to thrive as a Remote RN Auditor, and why are they important?

To thrive as a Remote RN Auditor, you need a strong background in nursing, clinical documentation, and auditing practices, typically with an active RN license and experience in medical record review. Familiarity with electronic health record (EHR) systems, coding standards (such as ICD-10 and CPT), and auditing software is essential. Attention to detail, strong analytical thinking, and effective written communication are standout soft skills in this role. These capabilities ensure accurate audits, regulatory compliance, and clear reporting in a remote healthcare environment.

What are some common challenges faced by Remote RN Auditors, and how can they be effectively managed?

Remote RN Auditors often encounter challenges such as navigating complex electronic health record systems, ensuring data accuracy while working independently, and staying updated on frequently changing compliance regulations. To manage these, successful auditors develop strong organizational skills, maintain regular communication with team members, and participate in ongoing training. Proactively seeking clarification on ambiguous cases and leveraging available resources from their organization can also help maintain high-quality audit outcomes and job satisfaction.

What is a Remote RN Auditor?

A Remote RN Auditor is a registered nurse who reviews medical records, clinical documentation, and billing information to ensure compliance with healthcare regulations and standards—all while working remotely. Their primary focus is to verify accuracy in coding, billing, and adherence to clinical guidelines, often for insurance companies, hospitals, or healthcare organizations. They play a crucial role in identifying errors, preventing fraud, and improving the quality of patient care. This job typically requires an active RN license, strong attention to detail, and experience with healthcare compliance and auditing.
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Remote Rn Auditor jobs near you

Registered Medical Review Nurse - Training and Quality Control Coordinator

Broadway Ventures

Columbia, SC • On-site, Remote

$18.25 - $25.25/hr

Other

Posted 19 hours ago

Job description

Job Description: Registered Nurse - Training and Quality Control Coordinator

Position Title: Registered Nurse - Training and Quality Control Coordinator
Company: Broadway Ventures, LLC
Location: Columbia, SC / Remote or Hybrid as assigned

Position Summary

Broadway Ventures is seeking a qualified Registered Nurse - Training and Quality Control Coordinator to support medical review operations for Palmetto GBA. This role is responsible for reviewing medical review decisions for accuracy, ensuring proper application of CMS guidelines, supporting quality control initiatives, training clinical staff, and assisting with provider inquiries and appeals-related medical coverage issues.

The ideal candidate will have strong clinical judgment, experience applying CMS instructions and medical review procedures, and the ability to provide education, feedback, and quality assurance support to medical review teams.

Key Responsibilities

The Registered Nurse - Training and Quality Control Coordinator will be responsible for the following:

  • Review medical review decisions for accuracy and ensure CMS instructions and guidelines are applied correctly.
  • Develop, implement, and support a quality control program designed to evaluate clinical staff's technical knowledge and medical judgment.
  • Provide feedback to management and staff regarding quality review findings.
  • Deliver remedial training when necessary to address identified performance or knowledge gaps.
  • Assist provider service departments with medical coverage issues to ensure consistent application of CMS guidelines.
  • Respond to specific provider inquiries and appeals requests related to medical coverage and review decisions.
  • Develop and maintain departmental reference manuals used to support proper application of CMS instructions.
  • Provide continuing education workshops for medical reviewers on coverage issues, CMS updates, and medical advances.
  • Train new staff on CMS guidelines, medical review procedures, and internal review processes.
  • Prepare monthly reports for management outlining quality control results, adjustment data, and reopening results summaries.
  • Provide input to the medical review audit department regarding actions taken in response to provider billing practices to help identify and target potential program abuse.

Required Qualifications

  • Active and unrestricted Registered Nurse license.
  • Strong knowledge of CMS guidelines, medical review procedures, and healthcare coverage requirements.
  • Experience reviewing medical documentation and applying clinical judgment to coverage or medical necessity decisions.
  • Ability to evaluate clinical staff performance and provide constructive feedback.
  • Experience developing or supporting quality control, quality assurance, or audit programs.
  • Strong written and verbal communication skills.
  • Ability to create reports, reference materials, training guides, and educational content.
  • Strong organizational skills and attention to detail.
  • Ability to work independently and collaborate with management, clinical staff, provider service teams, and audit departments.

Preferred Qualifications

  • Prior experience with Medicare, Medicaid, CMS contractors, or healthcare claims review.
  • Experience responding to provider inquiries, appeals, or coverage-related requests.
  • Background in medical review, utilization review, quality assurance, auditing, or clinical education.
  • Experience training clinical staff or developing continuing education workshops.
  • Familiarity with provider billing practices and program integrity concepts.

Knowledge, Skills, and Abilities

  • Advanced clinical assessment and medical judgment skills.
  • Understanding of CMS instructions and their application to medical review decisions.
  • Ability to identify trends, errors, and training needs through quality control reviews.
  • Strong analytical skills for preparing monthly management reports.
  • Ability to communicate complex medical coverage issues clearly and professionally.
  • Commitment to accuracy, compliance, consistency, and continuous improvement.

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