Medical Auditor

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Execute clinical validation audits and analyze medical documentation to ensure precise representation of patient conditions in accordance with coding guidelines.

• Carry out prospective, retrospective, and RADV audits as requested by clients.

• Implement coding principles throughout medical audit processes and deliver educational support as necessary.

• Gather comprehensive findings and formulate client reports following medical record audits.

• Discuss audit outcomes with clients on a monthly basis or as required.

• Offer insights and suggestions for process enhancements to the Client Service Liaison.

• Engage in workgroups, committee sessions, process improvement projects, departmental meetings, client calls, and performance assessments.

• Inform the Client Service Liaison of potential trends indicating inappropriate utilization.

• Keep up-to-date with current professional licenses and certifications.

• Participate in training conferences, webinars, workshops, and review industry publications to remain informed on ICD-10-CM coding, documentation, laws, and regulations.

• Comply with HIPAA regulations.

• Exemplify AnewHealth’s core values.

• Undertake additional duties as assigned.

⛳️ Requirements

• Professional Medical Coder Certification: CCS from the American Health Information Management Association, CPC, or RHIT with six months of ICD-10-CM coding experience.

• CRC certification is preferred.

• CPMA certification is preferred.

• Background in clinical documentation improvement.

• Familiarity with Hierarchical Condition Categories (HCC).

• Understanding of or experience with Medicare Advantage plans.

• Knowledge of or experience in managed health care systems, PACE, or Medicare.

• Proficient in MS Word, Excel, and PowerPoint.

• Willingness to learn and become proficient in new and proprietary software.

• Must maintain professional licenses and certifications.

• Able to commute to various site locations within the assigned territory.

• May need to work extended hours.

• Availability outside of regular business hours on an ad-hoc basis.

• Applicants must have the legal right to work in this country.

🏝️ Benefits

• Coverage for medical, dental, and vision.

• Flexible spending account.

• Company-sponsored life insurance.

• Short-term disability coverage.

• Optional benefits.

• 401(k) plan.

• Paid Time Off.

• Paid holidays.

• Flexible remote work options.