Medical Coding Auditor, CPC, CCS-P, CPMA
Crossroads
Clinical Auditor 2
Savista
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $28 - $40 per hour
Job Level
Mid-LevelSenior
About the role
- Performs audits of medical records to identify and/or defend charges, including: Defense Audits, Patient Inquiry Audits, Disallowed Charges, Biller Requested Audits
- Completes analysis of records against established criteria to determine if patient condition and/or care meets that criteria
- Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and patient
- Compose appeal letters addressing and appealing both contract issues and medically related issues
- Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution
- Enter audit findings and/or data into Client’s computer based system
- Function in a professional, efficient and positive manner
Requirements
- RN/Case Management /Utilization Review/Coding or clinical certification with a BS/BA preferred otherwise equivalent years of technical experience
- 3 to 5 years of clinical experience or 3 to 5 years of clinical auditing experience in either case management, Medicare appeals, utilization review or denials management
- Knowledge of Milliman (MCG) or InterQual criteria preferred
- Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization
- Fundamental knowledge of Medicare/Medicaid Guidelines
- Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling)
- Skilled with Microsoft Outlook, Word, Excel and EMR
Benefits
- Health insurance
- Retirement plans
- Paid time off
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical auditingmedical records reviewclaims processingutilization reviewcase managementMedicare appealsdenials managementMilliman criteriaInterQual criteriaMedicare/Medicaid Guidelines
Soft skills
organizationprioritizationcommunicationprofessionalismefficiencypositive attitudemulti-tasking
Certifications
RNCase Management certificationUtilization Review certificationCoding certificationBS/BA
