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Remote Rn Auditor Jobs in Silver Spring, MD (NOW HIRING)

CareFirst

Clinical Appeals Nurse (Remote)

Baltimore, MD · Remote

... RN direct patient care or health insurance payor experience. Preferred Qualifications: * Three (3) years Medical Review, Utilization Management, Nurse Auditor/Revenue Integrity, and/or Appeal and ...

Sunshine On The Go Nursing

Be Seen First

Client Care Coordinator

Mclean, VA · On-site

$20.50 - $22/hr

About Sunshine On The Go Nursing We are a growing home care agency dedicated to providing compassionate, high-quality care while delivering exceptional service to our clients, families, referral ...

Sunshine On The Go Nursing

Be Seen First

Client Care Coordinator

Mclean, VA · On-site

$20.50 - $22/hr

About Sunshine On The Go Nursing We are a growing home care agency dedicated to providing compassionate, high-quality care while delivering exceptional service to our clients, families, referral ...

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Remote Rn Auditor information

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$20

$34

$48

How much do remote rn auditor jobs pay per hour?

As of Jul 9, 2026, the average hourly pay for remote rn auditor in Silver Spring, MD is $34.10, according to ZipRecruiter salary data. Most workers in this role earn between $29.81 and $37.26 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.

Can you work remotely as an auditor?

Remote Rn Auditor positions are available and typically involve reviewing healthcare documentation and compliance from a home office. These roles often require strong computer skills, familiarity with auditing software, and adherence to confidentiality standards, making remote work feasible for qualified professionals.

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.

How to make $300,000 as a nurse online?

A Remote RN Auditor can increase earnings by gaining specialized certifications, such as in coding or compliance, and working for multiple clients or agencies to maximize income. Building a strong reputation and leveraging telehealth platforms can also lead to higher-paying opportunities, but reaching $300,000 annually typically requires extensive experience, advanced skills, and possibly additional roles or consulting work.

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 the highest paying remote nurse job?

The highest paying remote nurse jobs typically include roles such as remote nurse anesthetists, nurse practitioners, and clinical nurse specialists, with salaries often exceeding $100,000 annually. These positions usually require advanced certifications, specialized skills, and experience in telehealth or case management environments.

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.

How do you become a nurse auditor?

To become a nurse auditor, you typically need a registered nurse (RN) license and experience in healthcare or medical billing. Many employers prefer candidates with knowledge of insurance claims, coding, and auditing procedures, and some may require certification such as the Certified Professional Medical Auditor (CPMA).
More about Remote Rn Auditor jobs
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Remote Rn Auditor jobs near you
Clinical Appeals Nurse (Remote)

Clinical Appeals Nurse (Remote)

CareFirst

Baltimore, MD • Remote

Other

Retirement

Posted 13 days ago

CareFirst BlueCross BlueShield rating

7.3

Company rating: 7.3 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

215th of 278 rated insurance

Job description

Resp & Qualifications

PURPOSE: 
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider appeals regarding adverse coverage decisions and grievances. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Government Program lines of business to formulate a professional written response to the appeal or grievance request. We are looking for experienced clinicians to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.
ESSENTIAL FUNCTIONS:

  • Investigates, interprets, and analyzes appeal (reconsideration) and grievance requests from multiple sources including members, authorized representatives, and providers. Responds to such requests in writing letters that are complex and technical in nature, incorporating applicable medical criteria, and upholding corporate policies while meeting all State and Federal regulations and accreditation standards. 
  • Organizes the appeal case for physician review by compiling clinical, contractual, medical policy and claims information along with corporate and appellant correspondence.  Formulates recommendations for disposition. Prepares the written case for review and, following the physician review, when applicable, communicates the final decision to the members and providers including an explanation of the final decision and all External appeal rights.
  • Investigates, interprets, analyzes and prioritizes appeal and grievance requests using nursing expert knowledge and all available clinical information for both medical and behavioral health conditions, as well as medical policies, to determine if the adverse coverage and adverse decisions are appropriate. Interpret and apply, as appropriate Regulatory and accreditation requirements. Collaborates with Independent Review Entities/Organizations and contracted Panel Physicians in obtaining clinical opinions from physician specialists, to determine if adverse decisions are appropriate.  Interacts and responds to complaints from Regulatory Agencies and CMS.
  • Maintains a ready command of a continuously expanding knowledge base of current medical practices and procedures, including current medical, mental health and substance abuse/addiction procedural terminology, surgical procedures, dental procedures, diagnostic entities and their complications. 

QUALIFICATIONS:
Education Level:  Bachelor of Science in Nursing or related discipline OR in lieu of a bachelor's degree, four (4) years of relevant clinical nursing experience in addition to above experience requirements. 

Licenses/Certifications:

  • RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Required.
  • CCM - Certified Case Manager Upon Hire Preferred.

Experience: Three (3) years of clinically related experience working in Medical Review, Utilization Management, or other RN direct patient care or health insurance payor experience.
Preferred Qualifications:

  • Three (3) years Medical Review, Utilization Management, Nurse Auditor/Revenue Integrity, and/or Appeal and Grievance review at CareFirst BlueCross BlueShield, or similar Managed Care organization or hospital using MCG or InterQual criteria.  
  • Certified coder. 
  • Masters of Science in Nursing or related discipline.  

Knowledge, Skills and Abilities (KSAs)

  • Knowledge and understanding of medical terminology.
  • Demonstrated knowledge of regulatory and accreditation requirements, understanding of appeals process and utilization management, and systems software used in processing appeals. 
  • Excellent verbal and written communication skills, strong listening skills, critical thinking and analytical skills, problem solving skills, ability to set priorities and multi-task 
  • Ability to effectively communicate and provide positive customer service to every internal and external customer.
  • Knowledge of Microsoft Office programs.
  • Excellent analytical and problem-solving skills to assess the medical necessity and appropriateness of patient care and treatment on a case by case basis, including issues pertaining to members with mental health treatment needs or those with substance disorders and addictions.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: 67,320 - 133,705

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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