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Senior Auditor
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Posted: 10/20/2026Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical claims auditing, including ICD-9/ICD-10 coding and utilization management systems. Proven ability to collaborate with teams, document findings, and support audit processes while maintaining high-quality standards under tight deadlines.
Highest-signal resume keywords
Active RN LicenseICD-9/ICD-10 Coding ExpertiseMedical Records Review ExperienceUtilization Management Systems KnowledgeExcellent Written And Verbal Communication Skills
About the role
Key responsibilities & impact- Audit claims for medically appropriate services in inpatient and outpatient settings using medical review guidelines, policies, and rules
- Document audit findings with references to applicable policies and rules
- Generate letters articulating audit findings
- Support audit findings during the appeals process when requested
- Collaborate with the audit team to identify and obtain approval for vulnerabilities or potential abuse cases
- Partner with clients, CMD colleagues, and contractors to improve medical policies, provider education, and system edits
- Monitor medical practice, technology changes, and regulatory issues affecting clients
- Help minimize appeals, improve audit workflows, assist with QA functions, and train team members
- Participate in establishing edit parameters, new issue packets, and Medical Review Guidelines
- Interface with and support the Medical Director
- Cross-train in clinical departments and areas
- Perform other duties as required to meet business needs
Requirements
What you’ll need- Active unrestricted RN license in good standing is required
- Must not be currently sanctioned or excluded from the Medicare program by the OIG
- Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting
- One (1) or more years' experience performing medical records review
- One (1) or more years' experience in health care claims demonstrating expertise in ICD-9/ICD-10 coding, HCPCS/CPT coding, DRG, and medical billing experience for an insurance company or hospital
- Experience with utilization management systems or clinical decision-making tools such as MCG or InterQual
- Deep knowledge of ICD-9, ICD-10, CPT-4, or HCPCS coding
- Knowledge of insurance programs, particularly coverage and payment rules
- Ability to maintain high quality work while meeting strict deadlines
- Excellent written and verbal communication skills
- Ability to manage multiple tasks, including desk audits and claims review
- Ability to independently use standard office computer technology and case management systems/tools
- Ability to manage multiple assignments, document findings and suggestions, and organize and prioritize workload
- Ability to work independently and as part of a team in a remote setting
- Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or similar organization
Benefits
Comp & perks- Remote work arrangement
- Equal employment opportunity
- Reasonable accommodation during the application or recruitment process
- Employment at will
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claims AuditingICD-9 CodingICD-10 CodingCPT CodingHCPCS CodingMedical BillingUtilization ReviewClinical Decision-Making ToolsDocumentation Of Audit FindingsQuality Assurance Functions
Soft Skills
Ability To Manage Multiple TasksOrganizational SkillsTeam CollaborationIndependent Work CapabilityStrong Communication Skills
Tools & Technologies
Utilization Management SystemsCase Management SystemsStandard Office Computer Technology
Certifications & Qualifications
Active Unrestricted RN License
Industry Keywords
Health Care ClaimsMedical Review GuidelinesInsurance ProgramsProvider EducationRegulatory Issues