EnableComp

Nurse Review Auditor

EnableComp

full-time

Posted on:

Location Type: Remote

Location: Tennessee • United States

Visit company website

Explore more

✨ AI Apply
Apply

About the role

  • Perform comprehensive clinical audits to ensure medical necessity, regulatory compliance, and payer guideline adherence across a broad portfolio of high-complexity claims.
  • Apply expert clinical judgment to evaluate medical services, admission status, level of care, and coverage determinations for claims involving non-standard benefits, jurisdictional variances, and specialized regulatory frameworks.
  • Partner with internal and external stakeholders to identify trends, mitigate risk, and support accurate reimbursement through accurate documentation and well-supported clinical appeals.

Requirements

  • Active RN license with ADN or BSN required. Compact State licensure preferred.
  • Minimum of 2 years’ experience in:
  • Medical Necessity Reviews
  • Admission/Length of Stay
  • LCD/NCD interpretation and application
  • DRG validation and downgrade reviews
  • Line-item reviews
  • 3-5 years’ acute care hospital experience in one of more of the following:
  • ICU/Trauma
  • Surgery
  • Orthopedics
  • Neurosurgery
  • Strong knowledge of payer policies, CMS guidelines, and nationally recognized medical review standards.
  • Elevated level of analytical ability and attention to detail
  • Excellent written and verbal communication skills
Benefits
  • EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status.
  • We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
  • EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people.
  • We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here.
  • At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
clinical auditsmedical necessity reviewsLCD interpretationNCD interpretationDRG validationline-item reviewsadmission status evaluationcoverage determinationsregulatory compliancepayer guideline adherence
Soft Skills
analytical abilityattention to detailwritten communicationverbal communicationstakeholder partnershiprisk mitigationtrend identificationdocumentation accuracyclinical appeals support
Certifications
RN licenseADNBSNCompact State licensure