Profile summaryWhat this candidate is looking for
Registered Nurse specialized in Clinical Audit, Payment Integrity, and Healthcare Quality
Target rolesClinical AuditorNurse AuditorAppeals Nurse CoordinatorMedical Review NurseHealthcare Quality ConsultantProgram Integrity Specialist
SkillsClinical Validation & Documentation IntegrityICD-10-CM & CPT Coding ValidationDRG Validation & Reimbursement MethodologiesProvider EducationClinical Audit & Medical Record ReviewPayment IntegrityRecoverable Claims IdentificationFraudWaste & Abuse ReviewMedical Necessity & Utilization ReviewAppeals & Denials ManagementCMS Medicare & Medicaid ComplianceRoot Cause & Trend AnalysisQuality AssurancePerformance ImprovementAudit Findings DocumentationInter-Rater ReliabilityAdministrative Hearing DocumentationMedical Record AbstractionUtilization ReviewCorrective Action Plan DevelopmentHEDIS NCQA STAR Quality Measures ValidationClinical Documentation ComplianceSummary of Findings ReportsProvider Performance ImprovementDocumentation Integrity
Remote preferencesLocationColumbia, United States
SeniorityLead
Salary target$95k+
Employment typeremote, contract