Perform complete government, state and commercial payer clinical audit reviews
Assist with analyzing and reviewing clinical audit and DRG clinical validation audits
Contact regulatory bodies to determine the reason for audits
Review medical records to ensure compliance with healthcare standards
Analyze medical records and data to identify trends and discrepancies
Work effectively with healthcare providers, management, and other departments
Educate and train healthcare staff on best practices and regulations
Develop auditing and educational guidelines as needed

2+ years of regulatory audit experience, utilization review, clinical validation, denials or case management experience strongly preferred
Experience in hospital operations, chart audit/review, and clinical education
Ability to manage time, meet audit deadlines, and handle multiple tasks.
Experience working in a production-based work environment
Familiarity with electronic medical records (EMR) systems.
Registered Nurse (RN) License required.
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

RN Clinical Auditor

Key skills