Clinical Nurse Coding Auditor

Integrity Management Services, Inc.

. Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.

Posted 5/13/2026full-timeRemote • Virginia • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
Support fraud investigators with medical review expertise to detect and address fraudulent activities.
Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices.

Requirements

What you’ll need

Minimum **Associate’s Degree in Nursing** required;
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.
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.
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.

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 🔥 2 minutes ago ⚔️ Virginia – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Conduct in-depth medical reviews through prepayment claims review and post-payment auditing to identify potential over-utilization or fraudulent activities.
Assist in the creation of audit tools, policies, procedures, and educational materials to enhance audit effectiveness and maintain high standards in payment integrity.
Serve as a liaison with service operations and other departments to provide status updates on claims reviews and coordinate actions as needed.
Analyze performance data to identify patterns and trends, collaborate with service operations to address process improvements, and recommend modifications to medical policy.
Support fraud investigators with medical review expertise to detect and address fraudulent activities.
Act as a resource and mentor to other nurse auditors, supporting their professional growth and development in audit practices. 🎯 Requirements
Minimum **Associate’s Degree in Nursing** required;
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.
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.
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. 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 Coding Auditor 🔥 35 minutes ago Logan Health 1001 - 5000 Website LinkedIn All Job Openings Coding Auditor providing education, guidance, and auditing services to ensure coding compliance at Logan Health. Auditing outpatient records and coding accuracy for a healthcare provider in Montana. 🇺🇸 United States – Remote 💵 $26 - $35 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Clinician Documentation Auditor – Educator 🔥 2 hours ago US Acute Care Solutions 1001 - 5000 💊 Pharmaceuticals 📡 Telecommunications Website LinkedIn All Job Openings Clinician Documentation Auditor & Educator responsible for chart reviews and documentation accuracy. Analyzing coding trends and collaborating with clinicians to improve clinical documentation. 🇺🇸 United States – Remote 💵 $28 - $52 / hour 💰 Private Equity Round on 2021-02 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Coding Quality Auditor 🔥 4 hours ago Tenet Healthcare 10,000+ employees 🧬 Biotechnology 🧘 Wellness Website LinkedIn All Job Openings Conducts coding quality audits ensuring compliance with coding guidelines in healthcare. Consults with facility leaders on coding best practices and methodology. 🇺🇸 United States – Remote 💵 $30 - $46 / hour 💰 $2G Post-IPO Debt on 2022-05 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Quality Auditor 🔥 14 hours ago Medica 1001 - 5000 ⚕️ Healthcare Insurance 🤝 Non-profit Website LinkedIn All Job Openings Quality Auditor at Medica auditing claims for coding accuracy and compliance. Making recommendations for process improvement in a remote role. 🇺🇸 United States – Remote 💵 $45.9k - $68.8k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Senior Associate, Outpatient Coding Auditor 🔥 15 hours ago Gainwell Technologies 10,000+ employees ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Outpatient Coding Auditor performing coding reviews of medical records at Gainwell. Seeking candidates with strong outpatient coding experience and professional credentials. 🇺🇸 United States – Remote 💵 $70k - $80k / year 💰 Grant on 2023-06 ⏰ Full Time 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor 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 reviewaudit toolsCPT codingHCPCS codingICD-10 codingauditing principlesaccounting principlespayment integrityfraud detectiondata analysis

Soft Skills

analytical skillsproblem-solving skillsattention to detailcommunication skillsmentoringcollaborationreportingprofessional growth support

Certifications

Associate’s Degree in NursingRegistered Nurse (RN)AAPC certificationAHIMA certificationCPCCICCDI