Job Title: Nurse Auditor

Job Description

We are seeking a highly skilled Nurse Auditor who can understand the intricacies of standard medical coding, including CPT, ICD-10, and HCPCS. The successful candidate will be responsible for adjudicating claims, maintaining compliance with client contracts, and ensuring accuracy in payment criteria. This role requires auditing and pricing a wide variety of claim types and identifying claims requiring further review. The Nurse Auditor will also maintain productivity goals, uphold quality standards, complete special projects, and research unclear claims.

ResponsibilitiesAdjudicate claims to maintain compliance with client contracts and plan documentation.Determine accurate payment criteria for clearing pending claims based on defined policies and procedures.Audit and price a diverse range of claim types.Identify claims with inaccurate data and refer them to appropriate team members for review.Maintain productivity work task goals, quality standards, and manage aging timeframes.Contribute positively as a team player.Complete special projects as assigned.Comply with all departmental and company policies and procedures.Research unclear and unusual claims.Essential SkillsRegistered Nurse (RN) license required.3+ years of experience in medical record review, billing, and auditing.Vast knowledge of medical coding and/or Medicare Guidelines in inpatient, outpatient, or physician settings.Strong problem-solving skills.Ability to work independently.Additional Skills & QualificationsMedical Coding licensure preferred; open to candidates actively pursuing certification such as CPC, CIC, COC, CPMA, or AHIMA.Experience in health plan operations and insurance claims.Work Environment

Our work environment offers a hybrid schedule with 3 days in-office and 2 days remote, with work hours from Monday to Friday, 8 AM to 5 PM, and a flexible start time between 6 AM and 8 AM. Preferred candidates are located in the Des Moines surrounding area or within the state of Iowa. The team consists of 7 members, including 3 RNs and 4 coders, and boasts over 250+ years of combined expertise. The culture is tight-knit and collaborative, with a strong emphasis on excellence. The newly renovated building features on-site amenities such as a basketball court, arcade, and café, promoting a culture-focused and employee well-being-oriented organization. Software tools include AAPC Codify and proprietary pricing software.

Pay and Benefits

The pay range for this position is $75000.00 - $100000.00/yr.

Insurance Coverage: Health, dental, vision, disability, and life insurance plans.
Retirement Savings: 401(k) plan to help you plan for the future.
Flexible Spending Accounts (FSA): Options available for healthcare and dependent care expenses.
Leave Programs: Bereavement, parental, family, and medical leave to support life’s important moments.
Adoption Assistance: Financial support for employees expanding their families through adoption.
Paid Holidays:
New Year’s Day
Martin Luther King Jr. Day
Memorial Day
Independence Day
Labor Day
Thanksgiving Day
Day After Thanksgiving
Christmas Eve (½ day)
Christmas Day
New Year’s Eve (½ day)
Paid Time Off (PTO):
Full-time employees accrue up to 4.62 hours of PTO per pay period, totaling up to 120 hours annually.
After three consecutive years of full-time employment, accrual increases to 6.154 hours per pay period.

Workplace Type

This is a hybrid position in West Des Moines,IA.

Application Deadline

This position is anticipated to close on Aug 27, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.