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

Cinqcare

Registered Nurse

Laurel, MD · Remote

Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions ... The RN will establish the business strategy and roadmap: (1) improve outcomes for Grace at Home ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

... Recovery Auditor Validation Contract (RVC). Essential Functions * Perform accuracy review of ... Registered Nurse, with a current unobstructed license to practice nursing in the United States.

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

... Recovery Auditor Validation Contract (RVC). Essential Functions * Perform accuracy review of ... Registered Nurse, with a current unobstructed license to practice nursing in the United States.

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How much do remote rn auditor jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for remote rn auditor in Silver Spring, MD is $34.13, according to ZipRecruiter salary data. Most workers in this role earn between $29.86 and $37.31 per hour, depending on experience, location, and employer.

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 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?

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 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.

How do I become a remote RN auditor?

To become a remote RN auditor, you typically need a valid registered nurse license, relevant experience in healthcare or medical record review, and knowledge of coding and compliance standards such as HIPAA. Many employers also prefer candidates with certifications like Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS). Strong attention to detail and proficiency with electronic health record systems are essential for success in this role.
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Remote Rn Auditor jobs near you

CMS PACE Audit Leads - Non-Clinical & Clinical RN Positions

Baltimore, MD • Remote

NEXTPHASE HEALTH SOLUTIONS LLC
See more jobs at NEXTPHASE HEALTH SOLUTIONS LLCexternal

Part-time

Posted 18 days ago

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Job description

Join our remote federal oversight team to lead and execute compliance audits for the Programs of All-Inclusive Care for the Elderly (PACE). We are actively recruiting qualified compliance and clinical leaders to fill three specialized leadership roles for the upcoming audit cycle.


Overview & Work Arrangement

Primarily part-time; 100% Remote (must reside and perform all work within one of the 50 United States).


Available Positions & Role-Specific Requirements

1. PACE Audit Lead [Non-Clinical or Clinical (RN)]

  • Directs the full end-to-end audit lifecycle, coordinating planning, staffing, schedules, and conferences across multidisciplinary teams while integrating cross-element findings and overseeing root cause analyses.
  • Licensure: Active Registered Nurse (RN) with unrestricted licensure required if applying as a clinical professional.
  • Requirements: Demonstrated experience planning, coordinating, and leading CMS PACE program audits and review activities; comprehensive knowledge of CMS PACE regulations, guidance, and audit protocols; skilled in developing audit reports, corrective action recommendations, and communicating results directly to CMS and PACE organizations.

2. Service Delivery, Access, and Grievances (SDAG) Lead [Non-Clinical or Clinical (RN)]

  • Directs the compliance evaluation of participant requests, service delivery workflows, appeals, and grievances to ensure adherence to federal timeframes, required notices, and participant protections.
  • Licensure: Active Registered Nurse (RN) with unrestricted licensure required if applying as a clinical professional.
  • Requirements: Demonstrated expertise in CMS PACE SDAG audit protocols; thorough understanding of service delivery requirements, appeals, and grievance processes; experience reviewing case documentation, validating evidence, and evaluating workflows for CMS compliance.

3. Provision of Services Lead [Clinical (RN)]

  • Directs the clinical review element, evaluating whether required services were authorized, coordinated, and delivered in accordance with participant needs and federal program requirements.
  • Licensure: Active Registered Nurse (RN) with unrestricted licensure required.
  • Requirements: Extensive clinical knowledge of PACE interdisciplinary care delivery and participant assessment requirements; hands-on experience evaluating clinical records, care planning, service authorizations, quality of care standards, and clinical evidence to substantiate findings.


Mandatory Qualifications

  • Auditor Training: Successfully completed the CMS PACE 2026 auditor training.
  • Audit Experience: Verified participation in a minimum of two (2) CMS PACE audits during the 2026 audit cycle.
  • Experience: At least 2 years of relevant healthcare compliance, auditing, or clinical oversight experience.
  • Core Skills: Strong analytical, project management, and written communication skills to evaluate data, synthesize evidence, and produce defensible audit documentation.