Auditor

• Review inpatient medical records and claims to ensure accurate coding and reimbursement
• Assign and validate ICD-10-CM, ICD-10-PCS, and DRG codes
• Audit coding quality and identify opportunities for improvement
• Investigate and resolve provider disputes with a fair, fact-based approach
• Analyze complex clinical documentation and coding scenarios
• Collaborate with other teams to clarify coding and medical information
• Contribute to cost savings by improving payment accuracy and reducing errors

Inpatient Medical Coding Auditor

• Extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes
• Reviews inpatient hospital claims for proper reimbursement
• Handles provider disputes in a result-oriented and metrics-driven environment
• Contributes to overall cost reduction by increasing the accuracy of provider contract payments
• Ensures correct claims payment and appropriate diagnosis related group (DRG) assignments
• Analyzes, enters and manipulates database
• Responds to or clarifies internal requests for medical information

• review of information provided in medical records
• understanding of what each line of business allows
• knowledge of Evaluation & Management (E&M) codes
• communicate audit findings confidently
• analyze information and clarify internal requests for medical information
• follow established guidelines/procedures
• perform most work 5 days per week, 8 hours per day between 6AM-6PM

Medical Coding Auditor

• Perform internal audits, including the execution of information technology, strategic, operational, financial, and compliance risk-based audits
• Execute risk-based audits evaluating controls and processes for scalability, effectiveness, efficiency, and risk mitigation strategies
• Assist in audit planning, refinement of audit work programs, and wrap up of engagements
• Assist in drafting audit reports that summarize audit findings and recommendations
• Develop and communicate audit observations, recommendations, process improvement opportunities, and best practices and obtain management responses
• Monitor and report on the status and findings of audits
• Assist audit team in performing special projects and implementing internal audit best practices
• Performs other duties as assigned

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Inpatient Medical Coding Auditor

Inpatient Medical Coding Auditor

Medical Coding Auditor

IT Internal Auditor II