[Remote] Clinical Auditor - RN

Note: The job is a remote job and is open to candidates in USA. Briljent is seeking a detail-oriented Clinical Auditor Registered Nurse to support medical record reviews and billing compliance audits for the Indiana Health Coverage Programs. This role involves evaluating the quality of care, identifying compliance issues, and preparing audit documentation and reports.ResponsibilitiesReview medical records and related documentation to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulationsConduct medical record and compliance reviews independently and provide preliminary findings to the Lead ReviewerIdentify potential documentation deficiencies, and billing compliance issuesMaintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reachedAssist with audit responses and appeals as neededEnsure all work aligns with state, federal, and national healthcare and Medicaid guidelinesStay current on clinical guidelines, policies, regulations, and Indiana Medicaid program and policy updatesResearch Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and proceduresAdapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlinesSkillsAt least 1 year of Medicaid claims review, billing compliance, or healthcare reimbursement experienceKnowledge of CPT coding guidelines and ICD-10 standardsProficiency in Microsoft Excel, Word, and OutlookStrong analytical, critical thinking, problem-solving, and technical writing skillsAbility to work independently and collaboratively in a fast-paced environmentRN license preferred; Indiana license or compact license acceptedCoding certification such as CCS or CPC strongly preferredCandidate located in or near the Indianapolis area is preferredFamiliarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferredExperience working with healthcare providers strongly preferredKnowledge of healthcare claims data and fraud, waste, and abuse preferredCompany OverviewBriljent is a professional training company that offers change management and project management services. It was founded in 1998, and is headquartered in Fort Wayne, Indiana, USA, with a workforce of 51-200 employees. Its website is http://briljent.com.