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

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 ...

VIVA USA INC

Clinical Analyst & Coding Specialist

SC · On-site +1

$68.87 - $73.87/hr

... a Registered Nurse. Currently credentialed as CPC (Certified Professional Coder) or as CCS ... Fully Remote VIVA is an equal opportunity employer. All qualified applicants have an equal ...

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How much do remote rn auditor jobs pay per hour?

As of May 30, 2026, the average hourly pay for remote rn auditor in Lexington, SC is $28.24, according to ZipRecruiter salary data. Most workers in this role earn between $24.71 and $30.87 per hour, depending on experience, location, and employer.

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.

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.

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Remote Rn Auditor jobs near you
Clinical Analyst & Coding Specialist (Remote)

Clinical Analyst & Coding Specialist (Remote)

Serigor, Inc.

Columbia, SC • On-site, Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Job Title: Clinical Analyst & Coding Specialist (Remote)
Location: Columbia, SC
Duration: 12+ Months
Job Description:
The IT Healthcare Consultant - Business Analyst Advanced will support the medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval.
This position requires an individual with strong analytical skills and experience in:
  • Managing multiple work efforts simultaneously
  • Medical Coding
  • Nursing
  • Time management skills
  • CPT/HCPCS and ICD-10 translation
  • Ability to write and understand business and functional requirements.

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist):
Specific duties include, but are not limited to:
  • Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
  • Performs initial review of codes to determine scope of changes.
  • Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
  • Conducts meetings with Agency personnel, stakeholders, and process owners. (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
  • Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
  • Research business rules, requirements, and models to complete initial analysis and recommendations.
  • Maintains business rules, requirements, and models in a repository.
  • Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
  • May serve as a back-up to review patient records against established criteria to determine medical necessity.
  • Other project-related duties.
  • 5+ years written and oral communications skills, strong proficiency in English.
  • Knowledge of Microsoft Office Suite.

Required Education:
  • Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

Required Certifications:
  • Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
  • Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.

Required Skills (rank in order of importance):
  • 5+ years in healthcare insurance; medical review, program integrity, or appeals.
  • 5+ years working with IT developers/programmers in a payor environment.
  • 5+ years Medical Coding in payer environment.
  • 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
  • 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
  • 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

Preferred Skills (rank in order of Importance):
  • 5+ years' experience in policy remediation.
  • 5+ years claims processing systems experience.
  • 5+ years Optum Encoder and/or other medical coding software programs.

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