EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

Position Summary

The Clinical Nurse Auditor is responsible for performing comprehensive clinical audits to ensure medical necessity, regulatory compliance, and payer guideline adherence across a broad portfolio of high-complexity claims. This role applies expert clinical judgment to evaluate medical services, admission status, level of care, and coverage determinations for claims involving non-standard benefits, jurisdictional variances, and specialized regulatory frameworks. The Clinical Nurse Auditor partners with internal and external stakeholders to identify trends, mitigate risk, and support accurate reimbursement through accurate documentation and well-supported clinical appeals.

Nurse Review Auditor (REMOTE)

Skills

Job description

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