Medical Review Auditor

Job description

Job Title: Medical Review Auditor – Full Time

Location: New Jersey (Hybrid/Remote options may be available depending on contract requirements)

About Us:

Genesis Consulting Support is a healthcare compliance and staffing firm specializing in utilization review, claims auditing, and Medicaid/Medicare program integrity. We partner with government agencies, healthcare payers, and providers to ensure accuracy, compliance, and quality in healthcare delivery.

Position Overview:

We are seeking experiencedMedical Review Auditors to join our team in support of large-scale Medicaid provider audits. Each auditor will be responsible for reviewing and analyzing approximately 2,500 cases annually, ensuring compliance with State Medicaid regulations and federal guidelines. This role is critical in upholding healthcare program integrity and ensuring accurate and fair review outcomes.

Key Responsibilities:

• Conduct comprehensive medical record reviews and Medicaid provider audits in accordance with state and federal regulations.

• Apply clinical expertise to validate utilization review (UR) findings and identify inconsistencies or improper billing.

• Interpret and apply New Jersey Medicaid regulations and policies to all audit activities.

• Document audit findings clearly, accurately, and in compliance with contract requirements.

• Collaborate with supervisors, compliance staff, and government stakeholders to address complex cases.

• Maintain productivity and accuracy benchmarks while ensuring high-quality, evidence-based review results.

Qualifications:

• Active Registered Nurse (RN) license in the State of New Jersey.

• Minimum of 3 years of experience as a nurse conducting Medicaid or Medicare utilization review audits.

• Working knowledge of Medicaid provider audit procedures.

• Ability to interpret and apply State Medicaid regulations and policies effectively.

• Strong analytical skills, attention to detail, and ability to work independently.

Why Join Us?

• Competitive pay and benefits.

• Opportunity to work on high-impact projects that protect healthcare integrity.

• Supportive team environment with professional growth opportunities.

How to Apply:

Submit your resume and cover letter toinfo@genesisconsultingsupport.org with the subject lineMedical Review Auditor Application or apply directly via LinkedIn.

Please Note: This position iscontingent upon contract award. Offers of employment will be finalized once the contract has been awarded to Genesis Consulting Support.