Medical Review Auditor – Fraud Waste and Abuse

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

📋 Description

• Performs audits on medical records and healthcare claims to evaluate the precision of medical coding and ensure adherence to relevant policies, procedures, and regulations.

• Compiles and submits comprehensive reports detailing audit results, providing suggestions for rectifying deficiencies and enhancing practices or processes.

• Engages in medical policy and pertinent research to support audit conclusions.

• Applies expertise in healthcare coding standards, identifies areas of risk, understands reimbursement models, and detects questionable trends in medical documentation.

• Keeps abreast of current federal, state, and specific payer policies and coding guidelines.

• Involves in special projects as necessary.

⛳️ Requirements

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

• Preferred licenses include Licensed Practical Nurse (LPN) or Registered Nurse (RN).

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

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

• Proficiency in MS Office suite.

• Exceptional verbal and written communication abilities.

• Strong listening and observational skills.

• Attention to detail and a commitment to high accuracy.

• Effective organizational and prioritization skills, capable of handling multiple tasks simultaneously.

• Knowledge of ICD, CPT, HCPCS, APC, DRG, Revenue Codes, NCDs, and federal and state regulations (including CMS NCCI).

• Experience with healthcare claims is advantageous.

• Must have no adverse actions pending or recorded against him/her by any State or Federal licensing board or program.

🏝️ Benefits

• Medical, dental, vision, 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.