Medical Review Nurse – CMS/RAC Auditor, Government Audits

Machinify

Medical Review Nurse auditing government healthcare claims for Machinify’s AI-powered healthcare intelligence platform. Reviewing inpatient and outpatient records, documenting findings, and supporting appeals and medical policy improvements.

Posted 8/11/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical coding, including ICD-9, ICD-10, CPT-4, and HCPCS, while effectively managing audits and claims reviews. Possesses strong communication skills and the ability to collaborate with various stakeholders to enhance medical policies and workflows.

Highest-signal resume keywords

Utilization Management SystemsICD-9/ICD-10 CodingHealthcare Claims ExperienceActive RN LicenseRAC Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Review GuidelinesClaims AuditDocumentation of FindingsDesk AuditsMedical BillingClinical Decision-Making ToolsWorkflow ImprovementsQuality AssuranceCoding ExpertiseInsurance Program Coverage

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationTask ManagementTeam CollaborationOrganizational Skills

Tools & Technologies

MCGInterQualCase Management SystemsStandard Office Technology

Certifications & Qualifications

Active RN LicenseRAC Certification

Industry Keywords

Utilization ReviewInpatient ServicesOutpatient ServicesRegulatory IssuesProvider Education

About the role

Key responsibilities & impact

Audit claims for medically appropriate inpatient and outpatient services while applying medical review guidelines, policies, and rules
Document audit findings with appropriate policy and rule references
Generate letters explaining audit findings
Support findings during appeals when requested
Collaborate with the audit team to identify vulnerabilities and potential abuse cases and obtain approval
Partner with clients, CMD colleagues, and contractors to improve medical policies, provider education, and system edits
Monitor medical practice, technology changes, and regulatory issues affecting clients
Help minimize appeals, suggest workflow improvements, assist with QA, and train team members
Participate in establishing edit parameters, new issue packets, and Medical Review Guidelines
Interface with and support the Medical Director and cross-train across clinical departments
Perform other duties required by business needs

Requirements

What you’ll need

Experience with utilization management systems or clinical decision-making tools such as MCG or InterQual
Deep knowledge of ICD-9, ICD-10, CPT-4, or HCPCS coding
Knowledge of insurance program coverage and payment rules
Ability to maintain high-quality work while meeting strict deadlines
Excellent written and verbal communication skills
Ability to manage multiple tasks, including desk audits and claims review
Ability to independently use standard office computer technology and case management systems/tools
Ability to manage multiple assignments, document findings and suggestions, and organize and prioritize workload
Ability to work independently and as part of a team in a remote setting
Active unrestricted RN license in good standing required
Must not be currently sanctioned or excluded from the Medicare program by the OIG
Minimum five years of diversified nursing experience providing direct care in an inpatient or outpatient setting
One or more years of medical records review experience
One or more years of healthcare claims experience demonstrating expertise in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG, and medical billing for an insurance company or hospital
Strong preference for utilization review experience for an insurance company, Tricare, MAC, or similar organization
RAC certification preferred; candidates without it may need to work toward certification

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Machinify Website LinkedIn All Job Openings 1001 - 5000 employees 🏥 Healthcare 💼 Consulting 📦 Logistics 💰 $10M Series A - Machinify on 2018-10 Healthcare
Consulting
Logistics Machinify is a healthcare-focused AI platform and services company that reshapes healthcare payments and payment integrity. Its AI operating system unifies claims, medical records, contracts, and policies, and uses foundation models and task-specific agents to automate and improve coding, payment accuracy, recoveries, and cost avoidance. Machinify serves health plans (including 18 of the top 20), supports insourced, hybrid, or fully-managed deployments, and emphasizes measurable outcomes — reporting 85+ customers, 270M member lives covered, and $6B+ in annual cost avoidance and recoveries. Medical Review Nurse – CMS/RAC Auditor, Government Audits 🔥 1 minute ago 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Apply Now Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Audit claims for medically appropriate inpatient and outpatient services while applying medical review guidelines, policies, and rules
Document audit findings with appropriate policy and rule references
Generate letters explaining audit findings
Support findings during appeals when requested
Collaborate with the audit team to identify vulnerabilities and potential abuse cases and obtain approval
Partner with clients, CMD colleagues, and contractors to improve medical policies, provider education, and system edits
Monitor medical practice, technology changes, and regulatory issues affecting clients
Help minimize appeals, suggest workflow improvements, assist with QA, and train team members
Participate in establishing edit parameters, new issue packets, and Medical Review Guidelines
Interface with and support the Medical Director and cross-train across clinical departments
Perform other duties required by business needs 🎯 Requirements
Experience with utilization management systems or clinical decision-making tools such as MCG or InterQual
Deep knowledge of ICD-9, ICD-10, CPT-4, or HCPCS coding
Knowledge of insurance program coverage and payment rules
Ability to maintain high-quality work while meeting strict deadlines
Excellent written and verbal communication skills
Ability to manage multiple tasks, including desk audits and claims review
Ability to independently use standard office computer technology and case management systems/tools
Ability to manage multiple assignments, document findings and suggestions, and organize and prioritize workload
Ability to work independently and as part of a team in a remote setting
Active unrestricted RN license in good standing required
Must not be currently sanctioned or excluded from the Medicare program by the OIG
Minimum five years of diversified nursing experience providing direct care in an inpatient or outpatient setting
One or more years of medical records review experience
One or more years of healthcare claims experience demonstrating expertise in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG, and medical billing for an insurance company or hospital
Strong preference for utilization review experience for an insurance company, Tricare, MAC, or similar organization
RAC certification preferred; candidates without it may need to work toward certification 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 Professional Billing Quality Coding Auditor 🔥 3 hours ago Prisma Health 10,000+ employees 🏥 Healthcare Website LinkedIn All Job Openings Professional billing coding auditor improving coding accuracy for Prisma Health, a healthcare provider. Reviewing medical coding, preventing denials, and training coders on compliance and process improvement. 🇺🇸 United States – Remote 💰 Grant on 2024-08 ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor Medical Auditor – Project Lead 🔥 16 hours ago AAPC 51 - 200 💼 Consulting 🛡️ Insurance 📦 Logistics Website LinkedIn All Job Openings Medical Auditor Project Lead overseeing healthcare coding and documentation audits for AAPC. Managing client projects, auditor quality, regulatory research, and audit reporting. 🇺🇸 United States – Remote ⏰ Full Time 🟠 Senior 🔎 Auditor Coding Investigator Auditor 🔥 21 hours ago Health Care Service Corporation 10,000+ employees 🛡️ Insurance 💼 Consulting 🏥 Healthcare Website LinkedIn All Job Openings Coding Investigator Auditor auditing clinical, billing, and coding claims for HCSC, a health insurance company. Validating claims and documenting findings through research and cross-functional coordination. 🇺🇸 United States – Remote 💵 $55.9k - $123.5k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor Billing Quality Coding Auditor 🔥 22 hours ago Prisma Health 10,000+ employees 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Professional Billing Quality Coding Auditor reviewing CPT, ICD-10, and HCPCS accuracy for Prisma Health, a South Carolina not-for-profit healthcare organization. Training coders, preventing denials, and reporting review findings to leadership. 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🔎 Auditor 🦅 H1B Visa Sponsor RN Nurse Auditor 🕒 Yesterday Ochsner Health 10,000+ employees 🏥 Healthcare ⚕️ Healthcare Insurance 🤝 Non-profit Website LinkedIn All Job Openings RN Nurse Auditor conducting charge capture and clinical documentation audits for Ochsner Health, a not-for-profit Gulf South healthcare provider. Supporting revenue-cycle compliance and Chart Audit Committee reporting. 🇺🇸 United States – Remote 💰 Grant on 2023-07 ⏰ Full 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 About us Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass AI Apply Copilot OpenClaw job finder Find jobs using your resume 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