Clinical Auditor, Outpatient Specialty

This is a fully remote position, open to applicants in United States.

📋 Description

• Conducts audits for Outpatient and Specialty Claims.

• Applies medical chart coding principles along with client-specific guidelines.

• Works independently, reviewing and interpreting medical records.

• Employs advanced proficiency with Cotiviti encoder and auditing tools.

• Adheres to production goals while ensuring accuracy and quality standards.

• Identifies potential claims that are outside of concept for additional recoveries.

• Proposes, develops, and implements innovative ideas to enhance audit production and client satisfaction.

⛳️ Requirements

• An associate or bachelor’s degree in nursing (active/unrestricted license required).

• Coding Certification is mandatory and must be maintained, such as CPC, CIC, CCS, CCS-P, RHIA, or RHIT.

• 5 to 7 years of experience in clinical medical record coding or auditing.

• Familiarity with HIPAA Privacy and Security Rules as well as CMS security requirements.

• Comprehensive understanding of medical claims billing/payment systems and provider billing guidelines.

• Must adhere to official coding guidelines and coding clinic determinations.

• Requires expert knowledge in coding - DRG, ICD-10, CPT, and HCPCS codes.

• Strong verbal and written communication skills are essential.

• Capable of working effectively both independently and as part of a team.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Disability and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually.