Job Opportunities

Aridell Associates, LLC

Serving tHE Healthcare,

Financial, Insurance, and Public SectorS

Job Title: Registered Nurse Auditor (Part-Time Position Available)
Post Date: 10/16/2025 – 11/6/2025

About Us

Aridell Associates, LLC, a professional consulting firm, advises clients on healthcare program operations and helps clients develop solutions to maximize meaningful outcomes, improve their operations, and protect their valuable assets, as well as bestow customer confidence in their operations. Our mission is to advance clients’ operational performance and provide sustainable long-term, successful business strategies.

Position Summary

If you are interested in providing consulting and advisory services or supporting contracts, then this operational support position is for you. The Registered Nurse Auditor serves as an integral member of a multi-disciplinary team in conducting and supporting Medicare Advantage and Prescription Drug Plan Program audits and Program of All-Inclusive Care For the Elderly (PACE) audits on behalf of a client. The position will focus on reviewing and assessing medical records for compliance with established criteria. In this position, you will work collaboratively with other professionals; conduct research; collaborate on developing audit approaches, methodologies, and strategies; perform fieldwork; and report results. The Registered Nurse Auditor will receive all directions and instructions from a program manager or their designee for the work activities under a contract.

Responsibilities

Conduct performance audits, examinations and agreed-upon procedure engagements.
Review and analyze policies and procedures, medical records, encounter data, fee-for-service claims, enrollment data, prescription drug event records, and other data sources in assessing a health plan’s compliance.
Apply experience and knowledge of patient care and operational processes by making recommendations to improve patient care, health plan internal controls, and standard operating procedures.
Participate in on-site and off-site audit activities.
Interact and confer with team members on a variety of topics, such as ideas, projects, approaches, methodologies, and strategies, using all forms of available communications.
Identify and aid in the development of best practices for conducting audits.
Interpret Medicare and Medicaid policies, laws, rules, regulations, manuals, and healthcare industry guidelines in conducting audits.
Serve as a technical resource in health plan operations and data.

Qualifications

Must be a Registered Nurse with a current license and clinical documentation, medical necessity, and utilization review experience.
Bachelor’s degree in nursing with 5+ years related healthcare experience and knowledge of medical claims billing and payment is required.
Experience working for a health plan, regulatory government agency, special investigation unit, or program integrity contractor is preferred.
Must possess substantial familiarity with federal healthcare programs, such as Medicare Advantage Organizations, Medicare Prescription Drug Plans, and PACE plans, and the governing laws, rules, regulations, and policies.
Preference is given to candidates with outstanding organizational, time management, and interpersonal skills; superior technical writing and research ability; and a demonstrated commitment to professionalism and ethics.
The role requires one with a familiarity with managed care audits.

Knowledge and Skills

Must have an understanding of the medical aspects of coordinating care, patient care, and treatment plans.
Medical chart review experience in inpatient and outpatient settings assessing accuracy and completeness for the quality of care.
Experience with medical necessity determinations using clinical judgment based on generally accepted medical standards and recognized information.
Working knowledge of DRG, ICD-9/10, CPT, and HCPCS codes.
Knowledge of healthcare program billing criteria, guidelines, and reimbursement policies.
Strong organizational planning and prioritization skills with the ability to collaborate with others and multi-task.
Excellent written and verbal communication skills.
Ability to present to large or small groups when required.
Proficient in using the Microsoft Office Professional Suite, including Word, Excel, PowerPoint, and Outlook.

Travel Requirements

Audits may require occasional travel to audit sites. Travel is reimbursable.

Job Location

This is a work-from-home/remote position.

Apply Now
Email a cover letter and resume to: jarias@aridell.com

Current Job Opportunities

Job Title: Auditor (Multiple Positions Available)
Post Date: 9/29/2025 – 10/31/2025

About Us

If you are interested in providing consulting and advisory services or supporting contracts, then this operational support position is for you. The Auditor is well-versed in healthcare industry supply chains and possesses the skills to assess compliance with laws, rules, and regulations. The Auditor serves as an integral member of a multi-disciplinary team in supporting audits (agreed-upon procedure engagements) focused on drug manufacturers’ compliance with federal regulation for a client. In this position, you will collaborate with other professionals; conduct research; develop audit and analytical approaches, methodologies, and strategies; perform fieldwork; and report results. The Auditor is responsible for reviewing policies and procedures, internal controls, and supply chain transactional data to determine a drug manufacturer’s compliance with laws, rules, and regulations. The Audit Lead will receive all directions and instructions from an Audit Lead, program manager, or their designee for the work activities under a contract.

Responsibilities

Assess compliance with government laws and regulations.
Apply innovative audit strategies and methodologies to support the assessment of compliance with government laws and regulations.
Gather and organize information about a condition to be solved or the procedure or process to be improved.
Review and evaluate internal controls and supporting documentation.
Analyze financial, operational, and performance data, information, and other forms of evidence.
Participate in on-site and off-site audit activities.
Interact and confer with team members on a variety of topics, such as ideas, projects, approaches, methodologies, and strategies, using all forms of available communications.
Identify and aid in the development of best practices for conducting audits.
Review and analyze pharmaceutical industry data and other data sources in providing advice, input, and recommendations.
Interpret policies, laws, rules, regulations, manuals, and healthcare industry guidelines in conducting audits.
Develop recommendations to mitigate each reportable condition identified.