Medical Review Nurse - Home Health Auditor

Role Overview:

• Perform retrospective and prepayment audits on claims for Government and Commercial Payers.
• Work remotely in a fast-paced, dynamic environment as part of a multi-location team.
• Cross-train in all clinical departments and assist with QA functions.

Qualifications:

• Active RN license and associate or bachelor’s degree in nursing required.
• 2+ years of Home Health claims auditing, quality assurance, or recovery auditing experience required.
• Medical coding certification (CCDS, CDIP, CCS, CIC) preferred.

Skills & Competencies:

• Deep knowledge of ICD-9, ICD-10, CPT-4, and HCPCS coding.
• Experience with utilization management systems like MCG or InterQual.
• Strong analytical skills, attention to detail, and ability to work independently.

Work Environment:

• Fully remote position with opportunities for professional growth.
• Equal opportunity employer with a commitment to diversity and inclusion.
• Participate in E-Verify as required by applicable law.