Community Care Plan
North Branch, MN
Overview Certified Medical Coder required (AHIMA, AAPC, or PMI).
Hybrid-Sunrise, Florida
The Medical Coding Auditor conducts audits to provide investigative support related to potential fraud, waste, abuse and/or overpayment. Through post payment medical records review, the Medical Coding Auditor ensures appropriate coding on claims paid and maintains compliance documentation of any fraud, waste or abuse identified based on coding guidelines and regulatory and contract requirements.
Essential Duties and Responsibilities Performs post payment medical record review audits of claims payments to identify potential fraud, waste, abuse and/or overpayment.
Completes and maintains detailed documentation of audits including but not limited to coding guidelines reviewed, medical necessity documentation, decision methodology, and monetary discrepancies identified.
Coordinates overpayment recoveries with the Fraud Investigative Unit Manager.
Responsible for assisting the Fraud Investigative...