Medical Review Auditor – Fraud Waste and Abuse

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

📋 Description

• Review medical records and healthcare claims to evaluate the accuracy of medical coding and ensure adherence to policies, procedures, and regulations.

• Generate and submit comprehensive reports detailing audit results.

• Provide recommendations for addressing deficiencies and enhancing practices or processes.

• Conduct research on medical policies and related topics to support review conclusions.

• Utilize knowledge of healthcare coding standards, potential vulnerabilities, reimbursement methods, and patterns of questionable documentation.

• Stay updated on federal, state, and individual payer policy and coding standards.

• Engage in special projects as needed.

⛳️ Requirements

• Bachelor’s Degree in a relevant field, or a comparable combination of education, professional training, and work experience.

• Required credential: Certified Professional Coder (CPC, CCS, CCS-P).

• Preferred licenses: Licensed Practical Nurse (LPN) and Registered Nurse (RN).

• 2-5 years of pertinent experience in auditing medical records.

• Proficient in MS Office suite.

• Exceptional verbal and written communication skills.

• Strong listening and observational abilities.

• High attention to detail and accuracy.

• Effective organizational and prioritization skills with the ability to manage multiple tasks.

• Capability to conduct research to support medical review decisions.

• Familiarity with ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NCDs, and federal and state regulations, including CMS NCCI.

• Experience with healthcare claims is advantageous.

• Ability to work autonomously and collaborate effectively with colleagues and clients.

• Must not have any adverse actions pending or taken against him/her by any State or Federal licensing board or program.

• Capacity to manage stress positively, including high workloads and frequent changes.

• Must provide a dedicated, secure workspace.

• Access to high-speed internet is essential.

🏝️ Benefits

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Disability insurance coverage.

• Life insurance coverage.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays per year.

• 17-27 days of Paid Time Off (PTO) per year, depending on level and tenure.

• Work-from-home arrangement.

• Dedicated, secure workspace.

• High-speed internet access is necessary; all other equipment will be provided.