Clinical Auditor

CLINICAL AUDITOR is responsible for reviewing and evaluating the quality of healthcare services provided by healthcare organizations. The job description typically includes:

• Clinical Auditor works closely with internal and external departments providing support to ensure a continuous flow of potential patients into all clinic locations.
• The Clinical Auditor must be self motivated, possess a strong work ethic and a “can-do” attitude.
• The Clinic Audit Review Nurse is responsible for conducting detailed audits of clinical documentation, coding, and billing processes to ensure compliance with regulatory standards and internal policies.
• The role requires a strong understanding of ICD-10 and CPT coding, as well as experience with major insurance providers including Medicare, Blue Cross Blue Shield, Aetna, and others. The ideal candidate must be able to work independently with a high level of attention to detail.
• Conducting audits and assessments of clinical records, policies, and procedures to ensure compliance with regulatory requirements and industry standards.
• Up-to-date with industry developments, regulations, and best practices to maintain expertise and provide guidance to healthcare organizations.

Requirements

- Active Registered Nurse (RN) License (Preferably)

- Strong knowledge of ICD-10 and CPT coding systems

- In-depth industry knowledge regarding best practices, development, current regulations, and technology, particularly in Health Insurances such as Medicare, Blue Cross, Blue Shield, Aetna, and other insurance carriers

- With deep background in a remote set-up of work similar to freelancing as an Independent Contractor (deep understanding on the pros & cons involved in this industry).

- Exceptional attention to detail and analytical skills

- Ability to work independently with minimal supervision

- Strong organizational skills and ability to manage multiple tasks simultaneously

- Excellent communication skills, both written and verbal

- Experience in clinical audit, quality assurance, or healthcare compliance

- Familiarity with electronic health record (EHR) systems and auditing software

- Strong knowledge in healthcare compliance or auditing (e.g., CHC, CHCA) is a plus

- Creative mindset with the ability to develop innovative engagement initiatives, ability to work independently and as part of the team

- Flexible and able to perform multitasking in a fast-paced environment

- High levels of professionalism and endurance under stressful conditions

- With fast, reliable and stable internet connection (LAN or Fiber) and with internet backup

Benefits

• SALARY - Php 65,000 for Filipino PER MONTH

• TYPE OF WORK - FULL TIME (REMOTE), FROM MONDAY TO FRIDAY

• WORK SCHEDULE - US EAST COAST TIME ZONE

• JOB LEVEL - EXPERT OR ADVANCE LEVEL