Nurse Auditor, Clinical Claim Review (RN) - Weekdays

Remote, US-based · Part-time · 1099 independent contractor Please read before applying: this role is weekday coverage, Monday through Friday. We are hiring nurse auditors who can commit to a minimum of 15 hours per week, scheduled between 8:00 am and 8:00 pm [Eastern], Monday through Friday. Hours within that window are flexible and self-scheduled. Candidates who cannot commit to consistent weekday availability will not be a fit for this opening, regardless of clinical background. Work availability depends on client contracts and project needs. Hours and assignments may vary and are not guaranteed. About MHMDAA Michael Hill, MD and Associates (MHMDAA) is a clinical consulting firm specializing in expert witness opinions for payer–provider claim disputes. Our clients are law firms and insurers who rely on Dr. Michael Hill and our clinical team for defensible opinions on medical necessity, coding and billing accuracy, regulatory compliance, and claims-handling practices. We are a lean, fast-moving organization of roughly 30–35 contracted nurses, physicians, coders, and operations staff, supported by a technical and abstraction team. Our work product — the Claims Review (CR) report — ranges from ten pages to several hundred and is built from primary source medical records, payer policy, and regulatory guidance. The nurse auditor is the clinical checkpoint that makes those reports defensible. Position Summary The Nurse Auditor performs the clinical validation pass on draft Claim Review reports before they advance to physician and executive review. Draft CRs are assembled by our production team using standardized templates, scenario libraries, and AI-assisted abstraction. Your job is to independently verify that draft against the primary source record — confirming that every clinical statement, date, code, dollar amount, and citation is accurate and supported — and to supply the clinical judgment that automated abstraction and non-clinical staff cannot. This is detail-intensive, document-heavy work. You will not have live EMR access; records arrive as bulk PDFs, often scanned, sometimes thousands of pages, and occasionally mislabeled by opposing counsel. Comfort navigating large document sets and a healthy skepticism toward anything you have not personally verified are the core competencies of this role. Schedule and Availability Required days: Monday through Friday. This is a weekday-coverage position. Minimum commitment: Availability for at least 15 hours per week , with opportunities to work additional hours as available. Work depends on client contracts and project needs; hours and assignments may vary and are not guaranteed. Hours : Flexible and self-scheduled within an 8:00 am – 8:00 pm [Eastern] window. We ask for a minimum of four consecutive working hours on any day you declare yourself available, and that you are responsive during your declared hours. A 15-hour week can be built from evening blocks, daytime blocks, or a mix once off orientation. We operate seven days a week, with team members in the U.S. and overseas. Our primary working hours are 8:00 a.m.–8:00 p.m. Eastern Time. During orientation, you must be available for five consecutive business days (Monday–Friday), from 9:00 a.m.–5:00 p.m. Eastern Time, to accommodate preceptor availability. Availability tracker: Contractors post their weekly availability to a shared tracker and self-assign cases from the active queue when their scheduled shift begins. Team calls: Case review calls via Microsoft Teams are held daily at 9:00 am, 1:00 pm, 4:00 pm, 8:00 pm [Eastern]. You are expected to attend the calls that fall within your working hours and to escalate promptly between calls when a case raises questions. You are expected to be at your computer and available when on shift, with active work underway. Ad hoc meetings are frequently scheduled, and attendance is required if you are scheduled on shift. Onboarding: The first week is more intensive than steady state — expect a heavier schedule during training so you are fully independent before you begin working solo. Additional hours: Weekend work is sometimes available on top of weekday coverage once you are trained, subject to case flow. Volume is project-based and can slow around major holidays. Core Responsibilities Clinical validation Audit assigned draft CR reports section by section against the primary source medical record — demographics, dispute issue, clinical course summary, payer methodology, documentation, and conclusion. Lay eyes on the underlying record for every clinical assertion. AI-assisted abstraction is a starting point, not a source; omissions and consolidations are expected and it is the auditor's job to catch them. Apply the scenario-specific audit checklist for the case type (for example, ED level downgrades, inpatient medical necessity, two-midnight determinations, DRG validation, non-covered or self-administered drug denials). Validate the payer's own policy and criteria as applied to the case, and flag where the payer's determination does not hold up against its published methodology. Escalate ambiguous, non-standard, or systemic findings to the Senior Director of Clinical Review rather than resolving them silently in the document. Collaboration and continuous improvement Participate in daily case review calls and contribute observations that improve the checklists, templates, and standard language. Work alongside physicians, coders, and the technical team; provide the clinical perspective in tool and workflow design. Adapt quickly. Templates, checklists, and the audit platform are actively evolving; contractors who need a frozen process will find this role frustrating. Be technologically proficient, self-motivated, and capable of independently troubleshooting technical issues in a remote work environment.

Required Qualifications

Active, unencumbered RN license in the United States. Bachelor's degree required; BSN preferred. Minimum of five years of demonstrated experience in utilization review or management, medical coding, chart or claims auditing, payment or revenue integrity, clinical validation, or denials and appeals. Hands-on experience applying MCG or InterQual criteria. This is a requirement, not a preference — please tell us which you have used, how recently, and in what setting. Proven chart abstraction and retrospective chart review experience across large, unstructured document sets. Familiarity with Medicare and Medicaid coverage and regulatory guidance. Strong professional writing: the ability to summarize a clinical course accurately, concisely, and in a form that will withstand opposing review. Proficiency in Microsoft Word, Excel, Teams, and SharePoint; comfort working in Adobe Acrobat Pro across large PDF sets. Willingness to work with AI-assisted tools while independently validating their output. Confirmed availability of at least 15 hours per week, Monday–Friday, within the 8:00 am – 8:00 pm [Eastern] window. Shifts must be scheduled in a minimum of four-hour blocks. A private, HIPAA-compliant home workspace and reliable high-speed internet. Additional Qualifications That Are a Plus The following qualifications are a plus, but are not required: Coding certification — CCS, CIC, CPMA, CDIP, CRC or CPC. Experience with both MCG and/or InterQual . DRG validation and ICD-10 coding experience. Emergency department leveling and downcoding experience. Prior expert witness, litigation support, or legal claim dispute experience. Experience working with distributed and international teams across time zones. Engagement Terms Classification — 1099 independent contractor. No benefits. Compensation — Hourly, rate dependent on experience and credentials. Invoiced monthly. Location — Fully remote within the United States. Equipment — Contractor-provided computer, internet, and home office. Required software licenses and platform access are provided by MHMDAA. Schedule — Monday through Friday, minimum 15 hours per week, self-scheduled within the posted window. Contract-dependent work. Orientation – Must be available for five consecutive weekdays (Monday–Friday), from 9:00 a.m. to 5:00 p.m. [Eastern Time], to accommodate preceptor availability. Any time off exceeding five consecutive days during the first 30 days of employment must be disclosed and explicitly approved before hire.