RN Clinical Auditor

Ensemble Health Partners

RN Clinical Auditor reviewing government, state, and commercial payer audits for Ensemble’s healthcare revenue cycle management solutions. Ensuring compliance, accurate documentation, and audit prevention.

Posted 8/19/2026full-time🇺🇸 United StatesJuniorMid-Level💰 $63,100 - $108,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical audit processes, regulatory compliance, and healthcare standards, with a strong focus on analyzing claims and medical records. Proficient in utilizing electronic medical records (EMR) systems and collaborating with healthcare teams to enhance audit outcomes and implement corrective actions.

Highest-signal resume keywords

Registered Nurse (RN) LicenseClinical Audit ExperienceKnowledge of Medical Coding and BillingRegulatory Audit ExperienceExperience with Electronic Medical Records (EMR)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Audit ReviewsDRG Clinical ValidationClaims AnalysisHealthcare ComplianceChart Audit/ReviewClinical EducationMedical Coding (CPT, ICD-10)Utilization ReviewAudit Documentation PreparationCorrective Action Plans

Soft Skills

Problem-SolvingInterpersonal CommunicationVerbal CommunicationWritten CommunicationAttention to Detail

Tools & Technologies

Ensemble Health Partners Audit Tracking SystemElectronic Medical Records (EMR) SystemsMultiple Software Programs

Certifications & Qualifications

Associates or Bachelors Degree in Nursing

Industry Keywords

Healthcare RegulationsMedicareMedicaidCMS RulesLocal Coverage DeterminationsNational Coverage DeterminationsBilling ArticlesAudit Prevention ActivitiesQuality AssuranceClinical Guidelines

About the role

Key responsibilities & impact

Perform government, state, and commercial payer clinical audit reviews
Review clinical audits, DRG clinical validation audits, and clinically related claims
Analyze claims and medical records for compliance with healthcare standards, regulations, and payer requirements
Validate the accuracy and appropriateness of services provided
Contact regulatory bodies, payers, physician offices, government auditors, commercial auditors, and insurance plans regarding audits and denied claims
Gather, organize, and verify complete medical records and audit documentation from client EMR systems
Prepare audit materials and responses
Respond promptly to Notices of Review and requests for additional documentation
Record audit determinations in Ensemble Health Partners’ audit tracking system
Analyze audit data to identify trends, discrepancies, and improvement areas
Provide audit findings to the Clinical Audit Nurse Manager and Supervisor for reporting
Educate healthcare staff and client departments on audit outcomes, best practices, policies, and regulations
Participate in governmental audit client education sessions and MAC education sessions
Collaborate with healthcare providers, management, coding, CDI, revenue integrity, HIM, case management, and other departments
Provide feedback and assist in developing corrective action plans
Participate in developing clinical guidelines, protocols, auditing guidelines, and educational guidelines
Stay current with changes in healthcare regulations and ensure implementation in healthcare facilities
Support quality assurance and audit prevention activities

Requirements

What you’ll need

Associates or Bachelors Degree in Nursing required
Registered Nurse (RN) license required
2+ years of regulatory audit, utilization review, clinical validation, denials, or case management experience strongly preferred
Experience in hospital operations, chart audit/review, and clinical education
Ability to manage time, meet audit deadlines, and handle multiple tasks
Experience in a production-based work environment
Flexibility to adapt to changing regulations and healthcare environments
Ability to work independently and manage workload
Ability to evaluate complex situations and make informed decisions
Familiarity with electronic medical records (EMR) systems
Experience using multiple software programs and tools
Knowledge of clinical nursing practices and procedures
Understanding of medical coding and billing, including DRG, CPT, and ICD-10
Knowledge of CMS rules, policies, Local Coverage Determinations, National Coverage Determinations, and Billing Articles
Knowledge of healthcare regulations and standards, including Medicare and Medicaid
Strong problem-solving, interpersonal, verbal, and written communication skills
Keen attention to detail and thoroughness in reviewing patient charts and medical records
Must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require
Openness to innovation, including AI

Benefits

Comp & perks

Bonus incentives
Paid certifications
Tuition reimbursement
Comprehensive benefits package including healthcare, time off, retirement, and well-being programs
Professional development opportunities
Quarterly and annual incentive programs
Work-life flexibility
Remote work arrangement, with travel/on-site work as business needs require