Conducting audits of medical records, the full-time Certified Medical Review Auditor will evaluate the accuracy of medical coding and compliance with health plan policies for Fraud, Waste & Abuse clients while working remotely.
Key responsibilities
Conduct audits of medical records and healthcare claims to assess coding accuracy and compliance with regulations
Prepare and submit detailed reports on audit findings, recommending corrections and process improvements
Maintain current knowledge of federal, state, and payer policy and coding guidelines to support review findings
Required qualifications
Bachelor's Degree in a related discipline or equivalent combination of education and experience
Certified Professional Coder (CPC, CCS, CCS-P) credential required
2-5 years of related experience in auditing medical records
Preferred licenses: Licensed Practical Nurse (LPN) or Registered Nurse (RN)
Proficiency in MS Office suite