Focusing on Coding & Clinical Chart Validation, the full-time Clinical Auditor RN will conduct audits of outpatient and specialty claims, ensuring coding accuracy and medical necessity while utilizing advanced audit tools and maintaining productivity standards.
Key Responsibilities
• Audits outpatient and specialty claims by applying medical coding principles and interpreting medical records
• Utilizes advanced proficiency in audit tools to enter claims accurately and meet productivity and quality standards
• Identifies potential claims for additional recoveries and recommends new concepts and process improvements based on extensive auditing experience
Required Qualifications
• Associate or bachelor's degree in nursing with an active/unrestricted license
• Coding certification (e.g., CPC, CIC, CCS, CCS-P, RHIA, or RHIT) required and maintained
• 5 to 7 years of experience in clinical medical record coding or auditing with knowledge of HIPAA and CMS requirements
• Broad knowledge of medical claims billing/payment systems and coding terminology
• Expert knowledge of coding guidelines including DRG, ICD-10, CPT, and HCPCS codes