Clinical Nurse Coding Auditor, Part-time

Integrity Management Services, Inc.

Clinical Nurse Auditor ensuring accurate billing and compliance for Payment Integrity team. Conducting audits and analyzing utilization patterns to improve healthcare billing integrity.

Posted 4/15/2026part-timeRemote • Virginia • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

**Job Title:** **Clinical Nurse Auditor – Payment Integrity**
**Job Summary****We are seeking an experienced **Clinical Nurse Auditor** to join our **Payment Integrity** team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a **Registered Nurse (RN)** with coding certifications such as **CPC** (Certified Professional Coder), **CIC** (Certified Inpatient Coder), **CDI** (Clinical Documentation Improvement), or a similar credential, through **AAPC** or **AHIMA**. Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential.
**How You Will Make an Impact **
- **Investigations and Audits**: Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
- **Tool and Policy Development**: Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
- **Cross-Departmental Collaboration**: Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
- **Data Analysis and Trending**: Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
- **Fraud Detection Support**: Support fraud investigators with medical review expertise to detect and address fraudulent activities.
- **Mentorship**: Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.

Requirements

What you’ll need

**Qualifications**
- **Education**:
- Minimum **Associate’s Degree in Nursing** required;
- **Licensure & Certification**:
- Current, unrestricted **Registered Nurse (RN)** license in applicable state(s).
- Certification in medical coding from **AAPC** or **AHIMA** (e.g., CPC, CIC, CDI, or equivalent) is highly preferred.
- **Experience**:
- Minimum **5 years of clinical nursing experience**, preferably with exposure to hospital bill auditing or defense auditing.
- Strong knowledge of **provider manuals**, **reimbursement policies**, and **medical policy guidelines**.
- Prior experience with **healthcare fraud investigation** and auditing is highly preferred.
- **Skills**:
- Proficiency in CPT/HCPCS and ICD-10 coding, with a strong foundation in auditing, accounting, and control principles.
- Analytical and problem-solving skills with a keen attention to detail.
- Exceptional written and verbal communication skills for clear and effective reporting and provider engagement.
- Strong proficiency in Microsoft Office and familiarity with audit tracking systems.
**Preferred Traits**
- Meticulous, organized, and objective in analyzing claims and documentation.
- Ethical and responsible, with a commitment to supporting the integrity of healthcare billing and reimbursement.
- Able to work independently, stay current with rapidly changing healthcare regulations, and thrive in a fast-paced environment.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Integrity Management Services, Inc. Website LinkedIn All Job Openings 51 - 200 employees 📋 Compliance 🏛️ Government 🎯 Recruiter Compliance
Government
Recruitment Integrity Management Services, Inc. is a women-owned, women-run company specializing in helping government and commercial enterprises minimize the risk of improper payments, fraud, waste, and abuse. The company provides a range of services including data analytics, fraud investigations, compliance reviews, audits, grants management, staff augmentation, and coding and medical reviews. IntegrityM, as they are known, works closely with Federal Government agencies, state agencies, and private sector organizations to drive informed decisions and enhance program transparency and oversight. The company is recognized for its contributions to the community and has been awarded for excellence in government contracting and corporate social responsibility. Clinical Nurse Coding Auditor, Part-time Job not on LinkedIn 🔥 6 minutes ago ⚔️ Virginia – Remote ⏱ Part Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Apply Now Find Hiring Managers Customize resume for this job Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
**Job Title:** **Clinical Nurse Auditor – Payment Integrity**
**Job Summary****We are seeking an experienced **Clinical Nurse Auditor** to join our **Payment Integrity** team. In this role, you will leverage your clinical expertise, medical coding proficiency, and auditing skills to identify, monitor, and analyze unusual utilization patterns and potential fraud by healthcare providers. You will conduct prepayment claims reviews, post-payment audits, and comprehensive provider record reviews to ensure accurate billing, compliance with payer regulations, and integrity in reimbursement practices. This position requires a **Registered Nurse (RN)** with coding certifications such as **CPC** (Certified Professional Coder), **CIC** (Certified Inpatient Coder), **CDI** (Clinical Documentation Improvement), or a similar credential, through **AAPC** or **AHIMA**. Knowledge of commercial insurance plans, Medicare, and Medicaid programs is essential.
**How You Will Make an Impact **
- **Investigations and Audits**: Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
- **Tool and Policy Development**: Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
- **Cross-Departmental Collaboration**: Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
- **Data Analysis and Trending**: Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
- **Fraud Detection Support**: Support fraud investigators with medical review expertise to detect and address fraudulent activities.
- **Mentorship**: Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices. 🎯 Requirements
**Qualifications**
- **Education**:
- Minimum **Associate’s Degree in Nursing** required;
- **Licensure & Certification**:
- Current, unrestricted **Registered Nurse (RN)** license in applicable state(s).
- Certification in medical coding from **AAPC** or **AHIMA** (e.g., CPC, CIC, CDI, or equivalent) is highly preferred.
- **Experience**:
- Minimum **5 years of clinical nursing experience**, preferably with exposure to hospital bill auditing or defense auditing.
- Strong knowledge of **provider manuals**, **reimbursement policies**, and **medical policy guidelines**.
- Prior experience with **healthcare fraud investigation** and auditing is highly preferred.
- **Skills**:
- Proficiency in CPT/HCPCS and ICD-10 coding, with a strong foundation in auditing, accounting, and control principles.
- Analytical and problem-solving skills with a keen attention to detail.
- Exceptional written and verbal communication skills for clear and effective reporting and provider engagement.
- Strong proficiency in Microsoft Office and familiarity with audit tracking systems.
**Preferred Traits**
- Meticulous, organized, and objective in analyzing claims and documentation.
- Ethical and responsible, with a commitment to supporting the integrity of healthcare billing and reimbursement.
- Able to work independently, stay current with rapidly changing healthcare regulations, and thrive in a fast-paced environment. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Inpatient Auditor – Coding Integrity Specialist 🕒 4 days ago Huron 5001 - 10000 🤝 B2B 🏢 Enterprise 💸 Finance Website LinkedIn All Job Openings Inpatient Auditor reviewing coding accuracy and auditing coders for Huron Consulting Group. Ensuring adherence to coding standards and improving coding quality in inpatient settings. 🇺🇸 United States – Remote 💵 $26 - $36 / hour ⏱ Part Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Vehicle Inventory Representative, Auditor 🕒 4 days ago CCC Intelligent Solutions 1001 - 5000 Website LinkedIn All Job Openings Vehicle Inventory Rep documenting vehicle details for dealerships in Flint, MI. Completing audits and ensuring accurate data entry for CCC’s market valuations while working independently. 🇺🇸 United States – Remote 💵 $250 / month ⏱ Part Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Vehicle Inventory Representative, Auditor 🕒 April 7 CCC Intelligent Solutions 1001 - 5000 Website LinkedIn All Job Openings Vehicle Inventory Rep conducting audits and detailing used vehicles at dealerships. Flexible work arrangements with monthly dealership visits in College Station, TX. 🇺🇸 United States – Remote 💵 $200 / month ⏱ Part Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Lead Auditor – ISO 9001, ISO 14001, ISO 27001, AS9100, AS9110, AS9120, ISO 42001 🕒 March 28 DEKRA North America 1001 - 5000 🤝 B2B 🔒 Cybersecurity 🚗 Transport Website LinkedIn All Job Openings Lead Auditor for ISO 9001, 14001, and/or 27001 certifications conducting audits. Handling both remote and onsite auditing responsibilities across the Americas region including the U.S. 🇺🇸 United States – Remote ⏱ Part Time 🟠 Senior 🔎 Auditor Independent Contractor – Collision Center Auditor 🕒 March 28 DEKRA North America 1001 - 5000 🤝 B2B 🔒 Cybersecurity 🚗 Transport Website LinkedIn All Job Openings Independent Contractor conducting audits and delivering training for collision centers. Partnering with DEKRA to ensure compliance and excellence in the automotive industry. 🇺🇸 United States – Remote ⏱ Part Time 🟡 Mid-level 🟠 Senior 🔎 Auditor View More Auditor Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

medical codingauditingCPT codingHCPCS codingICD-10 codingdata analysisfraud detectionreimbursement policiesprovider manualshealthcare fraud investigation

Soft Skills

analytical skillsproblem-solving skillsattention to detailwritten communicationverbal communicationorganizational skillsmentorshipindependenceethical responsibilityadaptability

Certifications

Registered Nurse (RN)CPCCICCDIAAPC certificationAHIMA certification