SIU Nurse Auditor, RN, CPC

Integrity Management Services, Inc.

Clinical Nurse Auditor in Payment Integrity team reviewing claims and detecting fraudulent activities. Collaborating with departments and enhancing audit tools for compliance and integrity.

Posted 6/5/2026full-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. SIU Nurse Auditor, RN, CPC Job not on LinkedIn 🔥 1 hour 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 Medical Coding Auditor, CPC, CPMA 🔥 3 hours ago Veradigm® 1001 - 5000 ☁️ SaaS 🤝 B2B ⚕️ Healthcare Insurance Website LinkedIn All Job Openings RCS Medical Coding Auditor ensuring compliance in medical coding for Veradigm. Auditing professional fee coding while providing educational support and documentation accuracy. 🇺🇸 United States – Remote 💵 $57.7k - $80.2k / year 🔥 Funding within the last year 💰 $75M Post-IPO Debt - Veradigm on 2025-06 ⏰ Full Time 🟢 Junior 🟡 Mid-level 🔎 Auditor Pro Fee Auditor, Educator 🔥 3 hours ago Presbyterian Healthcare Services 10,000+ employees ⚕️ Healthcare Insurance 🤝 Non-profit Website LinkedIn All Job Openings Remote Pro Fee Auditor/Educator supporting coding compliance and quality assurance at Presbyterian Healthcare Services. Responsible for audits, training, and regulatory compliance in a remote setting. 🇺🇸 United States – Remote 💵 $54.5k - $83.3k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Medical Expert, Inspector/Auditor 🔥 4 hours ago Vander Weele Group 11 - 50 📚 Education 🏛️ Government Website LinkedIn All Job Openings Conducting medical assessments and compliance inspections for federal facilities. Collaborating with multidisciplinary teams to ensure quality healthcare evaluations and reporting. 🇺🇸 United States – Remote 💵 $75k - $105k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Quality Auditor – Building Inspections 🔥 5 hours ago ICC NTA, LLC 51 - 200 📋 Compliance 🏠 Real Estate 🏢 Enterprise Website LinkedIn All Job Openings Entry level ICC Building Inspector in Pennsylvania region for NTA, performing audits and quality assurance in building inspections. Training provided for motivated individuals to become seasoned inspectors. 🇺🇸 United States – Remote 💵 $45k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 🔎 Auditor 🚫👨‍🎓 No degree required Quality Auditor – Building Inspections 🔥 5 hours ago ICC NTA, LLC 51 - 200 📋 Compliance 🏠 Real Estate 🏢 Enterprise Website LinkedIn All Job Openings Entry level ICC Building Inspector performing inspections and audits for NTA in the Texas region. Individuals will be trained to obtain essential building code certifications. 🇺🇸 United States – Remote 💵 $50k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 🔎 Auditor 🚫👨‍🎓 No degree required 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

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

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

Hard Skills & Tools

medical reviewauditingCPT codingHCPCS codingICD-10 codingpayment integrityfraud detectiondata analysisaudit tools creationreimbursement policies

Soft Skills

analytical skillsproblem-solving skillsattention to detailwritten communicationverbal communicationmentoringcollaborationcoordinationprofessional growth supportstatus reporting

Certifications

Associate’s Degree in NursingRegistered Nurse (RN)medical coding certificationCPCCICCDI