Registered Nurse Clinical Auditor

About Us Founded in 2015, RADcube is a leading technology consulting and software development firm headquartered in Carmel, Indiana. The company specializes in transforming enterprise ideas into real-world innovations by leveraging emerging technologies such as Artificial Intelligence, Blockchain, and Cloud Computing. With nearly a decade of industry experience, RADcube serves diverse sectors, including healthcare, finance, government, and manufacturing. Their core service portfolio includes: Digital Transformation and strategy consulting. Custom Software Development tailored to specific business needs. Advanced Data Analytics and AI-driven platforms. Cybersecurity and risk management. Recognized for its innovation-led culture, RADcube operates RADlabs, an R&D hub focused on high-impact solutions like Responsible AI and Intelligent Automation. The firm is committed to a human-centric approach, ensuring cutting-edge technology delivers measurable business outcomes and long-term success for global clients. The company’s commitment to innovation has earned significant industry honors: 2026 TechPoint Mira Awards Finalist: Named a finalist for Tech Company of the Year, recognizing high-growth pioneers that demonstrate extraordinary leadership. Public Sector Excellence: Awarded the Utah NASPO Cloud & Software Solutions Contract, solidifying their role as a trusted partner for large-scale government digital initiatives and more. Job Description This is a remote position. Registered Nurse Clinical Auditor We are seeking a detail-oriented Registered Nurse to support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs. This role is responsible for evaluating the quality of care, reviewing medical records and program policies and identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings clinical knowledge, regulatory awareness, and strong analytical and writing skills. This is a remote position with occasional travel required within Indiana. Key Responsibilities · Review medical records and related documentation to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations. · Conduct medical record and compliance reviews independently and provide preliminary findings to the Lead Reviewer. · Identify potential documentation deficiencies, and billing compliance issues. · Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached. · Assist with audit responses and appeals as needed. · Ensure all work aligns with state, federal, and national healthcare and Medicaid guidelines. · Stay current on clinical guidelines, policies, regulations, and Indiana Medicaid program and policy updates. · Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures. · Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines. Requirements Qualifications · RN license preferred; Indiana license or compact license accepted. · Coding certification such as CCS or CPC strongly preferred. · Candidate located in or near the Indianapolis area is preferred. · At least 1 year of Medicaid claims review, billing compliance, or healthcare reimbursement experience. · Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred. · Knowledge of CPT coding guidelines and ICD-10 standards. · Proficiency in Microsoft Excel, Word, and Outlook. · Strong analytical, critical thinking, problem-solving, and technical writing skills. · Ability to work independently and collaboratively in a fast-paced environment. · Experience working with healthcare providers is strongly preferred. · Knowledge of healthcare claims data and fraud, waste, and abuse preferred.