4 rn crc coding auditor jobs found

Description Summary: The Compliance Auditor II will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws. Conducts audit activities, reporting and communicates audit findings. Works in conjunction with Compliance Director on compliance work plans, internal and external audits and reviews, and provides assurance that the organization is operating in an efficient and effective manner. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Manages compliance audit activities pertaining to compliance and coordinates with Corporate Compliance Director and Senior Leadership as it relates to such audits Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements. Work with VP/Senior/Manager/Director on...

Medical Compliance Auditor We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria. Think you've got what it takes? Job Duties & Responsibilities Assess the treatment plan, clinical information, and medical necessity of all requested services Utilizes established criteria to appropriately review billed services within established timeframe required. Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate....

Key Responsibilities Conduct detailed audits of patient medical records to ensure clinical documentation supports quality care, medical necessity, and accurate billing practices. Identify documentation, coding, billing, and compliance discrepancies and develop corrective action recommendations. Prepare comprehensive audit reports and communicate findings to leadership and operational teams. Monitor compliance risks related to Medicare, Medicaid, and other federal healthcare programs. Provide consultative guidance regarding healthcare compliance regulations and best practices. Assist with responses to government audits, investigations, and regulatory inquiries. Review potential refund and repayment obligations related to federal healthcare programs. Support policy and procedure development based on regulatory updates and audit findings. Monitor changes in healthcare laws, regulations, and compliance requirements. Collaborate with clinical, revenue cycle, finance, legal,...

Altegra Health is a total solutions partner for healthcare data auditing and analytics. Altegra provides end-to-end solutions to help improve payment integrity data, to support accreditation programs, and to meet regulatory requirements. Altegra's nationwide network of registered nurses and certified coders professionally acquire, audit, and analyze healthcare data for healthcare organizations. Altegra Health specializes in: 2. HEDIS 3. Medical Record Reviews (Accreditation) 4. And more Job Description These are a remote/home based temporary positions forecast to run through the end of 2015 and Coders will be paid by the chart. Remote Certified Coders review medical records and apply appropriate ICD-9-CM diagnostic codes and Altegra Health Flagged Event. Codes must meet Altegra Health QA standards (following both Official Coding Guidelines and Risk Adjustment Guidelines). Responsibilities Abstract pertinent information from patient medical records. Assign appropriate...