Remote Nurse Auditor – Medical Bill Review

About the role

Rising Medical Solutions is seeking a Nurse Auditor to join its remote team and help clients reduce healthcare costs. You will apply your clinical expertise to evaluate medical bills, ensure coding accuracy, and identify unnecessary charges.

Key responsibilities

• Audit medical and billing records to confirm services are reasonable, appropriate, and necessary.
• Identify and evaluate charges that are unrelated to the occurrence or not authorized.
• Verify compliance with CPT, ICD‑10, Medicare guidelines, and state fee schedules.
• Initiate contact with clients and medical providers to clarify discrepancies.
• Negotiate bills and conduct re‑evaluation reviews as required.

Required profile

• Active RN or LPN license in the states of operation.
• 3‑5 years of clinical experience in acute care, surgery, or orthopedics; workers’ compensation billing experience is a plus.
• CPC and/or CPC‑H certification strongly desired.
• Specialized training in hospital coding, orthopedic, neuro, rehab, or ER procedures.
• Strong customer‑service orientation and communication skills.

Required skills

• CPT coding
• ICD‑10 coding
• Medicare guidelines
• State fee schedule application
• CPC certification
• CPC‑H certification
• Hospital coding (ortho, neuro, rehab, ER)

What we offer

• Competitive benefits package including health insurance, 401(k) match, paid time off and holidays.
• Flexible hybrid schedule with remote work and occasional in‑office training days.
• Opportunities for career growth and internal promotion.
• Casual dress code and unlimited coffee in the office.