Nurse Auditor

Job Description

Job Description

Hybrid Nurse Auditor

Job Description

This role requires a thorough understanding of standard medical coding, including CPT, ICD-10, and HCPCS. The Nurse Auditor is responsible for adjudicating claims to comply with client contracts and plan documentation. This includes determining accurate payment criteria for pending claims, auditing and pricing a wide variety of claim types, and ensuring compliance with departmental and company policies.

Responsibilities

• Adjudicate claims to maintain and comply with client contracts and plan documentation.
• Determine accurate payment criteria for clearing pending claims based on defined policies and procedures.
• Audit and price a wide variety of claim types.
• Identify claims with inaccurate data or claims that require review by appropriate team members.
• Maintain productivity work task goals, quality standards, and 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.

Skills

Additional Skills & Qualifications

Job Type & Location

This is a Permanent position based out of West Des Moines, Iowa.

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 Oct 10, 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.