Medical Review Nurse – Home Health Auditor

Machinify

Medical Review Nurse II performing audit reviews for government and commercial claims in home health sector. Collaborating with a remote team to enhance audit workflows and ensure quality compliance.

Posted 7/23/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Home Health Claims Auditing, applying clinical criteria and documentation requirements to ensure compliance and accuracy. Proficient in ICD-10-CM/PCS coding and committed to quality assurance and continuous improvement in audit processes.

Highest-signal resume keywords

Home Health Claims AuditingICD-10-CM/PCS CodingMedical Coding CertificationQuality AssuranceAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Criteria KnowledgeDocumentation RequirementsMedical Review GuidelinesAudit Findings DocumentationCritical Judgment Application

Soft Skills

Attention to DetailCuriosityIndependent Work

Certifications & Qualifications

Active/Unrestricted RN LicenseMedical Coding Certification

Industry Keywords

Home HealthUHDDS DefinitionsOfficial Coding GuidelinesAHA’s Coding Clinic GuidelinesQuality Assurance Functions

About the role

Key responsibilities & impact

Auditing claims for medically appropriate services provided for inpatient settings while applying appropriate medical review guidelines, policies and rules.
Document all findings referencing the appropriate policies and rules.
Generate letters articulating audit findings.
Support your findings during the appeals process if requested.
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.
Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members.
Cross train in all clinical departments/areas.
Other duties as required to meet business needs.

Requirements

What you’ll need

An associate or bachelor’s degree in nursing (active/unrestricted RN license) is required.
Medical Coding certification is preferred.
Home Health claims auditing, quality assurance and/or recovery auditing experience of 2 years or more required.
Must have Home Health experience.
Strong focus on quality and attention to detail.
Deep curiosity and analytical skills to understand root causes of events and behaviors.
Proven ability to apply critical judgment in clinical determinations; medical coding ability preferred.
In-depth knowledge of clinical criteria and documentation requirements to support code assignments.
Understanding of ICD-10-CM/PCS coding, UHDDS definitions, Official Coding Guidelines, and AHA’s Coding Clinic Guidelines is preferred.
Ability to work independently and efficiently in a remote environment.

Benefits

Comp & perks

Equal Employment Opportunity at Machinify