Healthcare Audit Policy Analyst (Registered Nurse or Medical Coder)

Lead the development, maintenance, testing, and optimization of payment integrity audit concepts across government and commercial claim types. You’ll review and update audit policies and code lists, perform QA validation against coding and payer rules, monitor concept performance with statistical analysis, and resolve discrepancies with clinical and operations teams. You’ll also create training and reference materials and support client service inquiries, using ICD-10, CPT/HCPCS, and Medicare/Commercial payment methodologies.