Auditor

• leads day-to-day activities of the audit team
• provides allocation of resources
• establishes priorities
• manages vendor relationships
• periodically audits work of vendors
• conducts provider meetings to discuss audit findings
• negotiates settlements
• researches claims payment methodologies
• prepares and analyzes reports on recoveries

Clinical Provider Auditor Lead – Behavioral Health

• Supports codes from final surgical/procedural operative reports signed by the provider.
• Reviews the complex (problematic coding that needs research and reference checking) medical records, ensures documentation is supported.
• Works with ModMed to ensure that the correct plans are used, modifiers attached and diagnosis attached.
• Audits provider medical records and charges for compliance with coding and documentation standards to ensure compliance with internal and government regulations.
• Provides continuing review and education of physician and ACPs to ensure appropriate level of care is reported.
• Partner with practices to review findings of the periodic chart review.
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT coding guidelines to diagnoses and procedures in offices.
• Correlates information supporting clinical documentation not limited to Pathology, Radiology and/or other Physician Consultations after review by the Attending Physician, wherever appropriate.
• Regularly meets with physicians and ACPs to provide continuous education on billable services, medical record documentation, the correct use of CPT and ICD-10 codes, missed billing opportunities and erroneously reported services to minimize errors and loss of revenue.
• Interacts with and provides trends to management, revenue managers and others about coding related issues.
• Solves any coding related problems and/or answers questions regarding coding issues from the provider, office staff and billing specialists.
• Collaborates with billing specialists and appeal and edit coders to expedient resolution of accounts.
• Works together with billing specialists to develop plans to improve charge capture and billing/coding processes.
• Stays current with CPT and ICD-10-CM coding guidelines and updates.
• Communicate changes and/or updates to key stakeholders including physicians, ACPs, practice managers and leadership.
• Reports any potential compliance issues to the Director of RCM.

Provider Coding Auditor, Educator

• Auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed
• Analyzing and auditing claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities
• Utilizing audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters
• Maintaining accuracy and quality standards as established by audit management
• Identifying potential documentation and coding errors by recognizing aberrant coding and documentation patterns
• Suggesting and developing high quality, high value, concept and or process improvement and efficiency recommendations

Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG

• The Premium Insurance Field Auditor conducts insurance policy audits for Worker’s Compensation, Auto and General Liability policies.
• This is done by auditing the policyholder’s records according to client company standards.
• If you are looking for a fast paced, self-motivating work environment from home, this job may be for you!
• Working from your home office, this role requires scheduling appointments with the insured to be audited and obtain necessary documentation for our insurance company client audits all while adhering to customer requirements and quality standards.
• Territory: Baltimore, MD and surrounding areas

Premium Insurance Field Auditor

• The Premium Insurance Field Auditor conducts insurance policy audits for Worker’s Compensation, Auto and General Liability policies.
• This is done by auditing the policyholder’s records according to client company standards.
• Working from your home office, this role requires scheduling appointments with the insured to be audited, and travel on an average of 4 days per week within your assigned territory to meet with the insured and obtain necessary documentation for our insurance company client audits all while adhering to customer requirements and quality standards.

Experienced Premium Insurance Field Auditor

• Performs audit activities as assigned by the Area and/or Regional Manager.
• Audit responsibilities will include determining audit priorities and scheduling to meet stated deadlines, preparation of appointment letters, performing detailed review of all related business records, and preparing written reports of findings.
• Meets with business owners/managers to review audit results and implement any actions required.
• Transmits completed reports to Quality Review for handling by the required due date.
• Corrects and completes audits previously returned for correction and transmits back to Quality Review in a timely manner by Auditor expectations and SOP.
• Maintains accurate audit and business records related to, but not limited to, audit assignments, expense reports, time reporting, etc.
• Performs other duties as assigned.

Insurance Field Auditor

• Auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed
• Analyzing and auditing claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities
• Drawing on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions
• Utilizing audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters
• Maintaining accuracy and quality standards as established by audit management
• Identifying potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs)
• Suggesting and developing high quality, high value, concept and or process improvement and efficiency recommendations

• Protect assets by ensuring compliance with internal control procedures, and regulations
• Ensure compliance with established internal control procedures by examining records, reports, operating practices, and documentation
• Verify assets and liabilities by comparing items to documentation
• Conduct property audits, develops, recommends and implements property administration policies
• Develop plans and programs for achieving and maintaining product quality throughout the item’s life cycle
• Monitors operations to prevent the production of defects and to verify adherence to quality plans and requirements
• Prepare periodic and special purpose reports as required

Asset Physical Auditor – Government

• Ensure compliance with established internal and external control procedures by examining records, reports, operating practices, and documentation.
• Verify assets and liabilities by comparing operating procedures to documentation.
• Oversee internal and external audits and completes audit workpapers by documenting audit tests and findings.
• Maintain and ensure an ISO compliant library and assist with all commodities document libraries.
• Assist with establishing ISO/QMS systems at different GFC locations.
• Plan, organize and execute audits that conform to ISO 9001:2005 standard requirements, identify and communicate business risks and follow up on results and monitor closure of deviations.
• Support and provide oversight of the ISO 9001:2015 Internal Audit Program alignment with Marine Corps Statement of Work and Policies.
• Review and evaluate supply and maintenance system operations and procedures through periodic audits and surveillance inspections.
• Support and provide direct oversight of the Program ISO Control Documents Library.
• Provide administrative support for the Quality Management System Software (eQMS).
• Interpret Statement of Work and how it applies to MCPP KBR Operations.
• Review written management procedures for adequacy and evaluate the implementation and effectiveness.
• Analyze quality data to detect unsatisfactory trends or weaknesses in the Quality System.
• Investigate ISO Compliance findings and deficiency reports and provide identification of Root Cause and developing Corrective and Preventive Actions as needed.
• Evaluate and analyze current work methods to foster continuous improvement.
• Provide technical direction as required.
• Serve as a liaison to the customer Blount Island Command (Marine Corps) ISO Quality Representative, facilitating, communicating and maintaining an excellent working relationship with all government counterparts.
• Provide coordination with other groups to accomplish tasks outside normal areas of responsibility.
• Evaluate and implement changes in work procedures.
• Develop and implement new processes/procedures as needed.
• Facilitate and conduct internal training as required.
• Champion, coach and motivate teams and/or team members.
• Conduct meetings and technical presentations.

See all jobs on JobTailor

Clinical Provider Auditor Lead – Behavioral Health

Provider Coding Auditor, Educator

Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG

Premium Insurance Field Auditor

Experienced Premium Insurance Field Auditor

Insurance Field Auditor

Clinical Validation Auditor – RN, CDI, MS-DRG, AP-DRG, APR-DRG

Asset Physical Auditor – Government

Auditor – ISO 9001:2015