EMR Auditor/ RN

The Electronic Medical Records (EMR) RN will perform quality monitoring of patient information in transcribed reports.
Reviews electronic patient records for coding accuracy, documentation completeness, and compliance with regulations
(HIPAA, CMS), identifying errors, providing feedback/training to clinical staff, and generating reports to prevent financial loss
and ensure proper billing, often specializing in areas like ICD-10/CPT coding and CDI (Clinical Documentation
Improvement). The ideal candidate combines strong clinical nursing experience with a passion for technology, data
accuracy, and process improvements.
Starting Salary: $35.00 hr.
Full Time or Part Time: Full Time
Standard Hours per Week: Monday – Friday, 40 hours/week
Work Schedule: Shift starts 8:00 AM – 5:00 PM
Schedule Type: In Office
Coordinate the ordering of medical record and ensure accurate documentation and tracking of records and
related payments.
Verify eligibility based on plan benefits and language, and stop-loss policy provisions; accurately enter claim details
into the system of record.
Manage and maintain electronic claim files to support audit processes and ensure compliance with applicable
regulations.
Review, analyze, and adjudicate high-dollar and complex medical stop-loss claims; Identify cost-containment
opportunities and implement strategies with carriers and TPAs.
Document audit findings and maintain accurate records in the system.
Offer guidance to clients on claims procedures and coverage issues.
Stay current on regulatory requirements impacting clinical documentation and data use (risk adjustment, HIPAA).
Receive, log, and validate incoming medical records and related documentation; request missing information as
needed.
Develop and maintain EMR templates, documentation standards, and clinical data elements aligned with
analytical needs.
Communicate effectively and respond timely to TPAs, brokers, policyholders, and internal teams; provide clear
updates on claim status and documentation requirements.
Prepare detailed reports on audit findings, trends, and recommendations for management and Stakeholders
Accurately process and record lump sum payments in the system.

Requires a Bachelor’s of Science in Nursing or advanced degree preferred
Specialty in Oncology, Cardiology preferred
Minimum 5-10 years in medical stop-loss claims processing or related health insurance claims roles.
Proficiency in medical coding (ICD-10, CPT, HCPCS); advanced Excel skills; expertise with claims processing systems.
Strong understanding of stop-loss insurance, plan documents, and claims handling practices
Analytical and problem-solving skills for identifying systemic issues.
Auditing experience preferred
Exceptional analytical ability, attention to detail, and strong written and verbal communication skills.