Medical Auditor CCDs/CDI

Medical Auditor (Remote)

Job Description:

Medical auditors check the work of medical coders and billers. A medical auditor identifies incomplete documentation that could affect a healthcare facility's livelihood by examining the coding procedures and ensuring the organization complies with regulatory requirements.

Position: Medical Auditor (CCD / CDI)

• Location: Remote
• Type of Work: Full time, permanent
• Work Hours: Monday to Friday, 9:00 AM - 6:00 PM Eastern Standard Time (UTC -5)

The role and responsibilities:

Summary: The auditor is expected to identify fraudulent claims, outliers, reimbursement deficiencies, inefficiencies, incorrect codes and poor documentation to improve the organization being challenged by the government or insurance companies.

• Able to cross reference the codes and the charts.
• Provide education to other healthcare professionals regarding correct documentation and detailed recommendations to improve the organizations procedures and policies.
• Reviews emergency room medical records to assign ICD, CPT, HCPCS codes accurately.
• Interprets progress notes, operative reports, discharge summaries, and other documentation within the medical record to identify health-related patterns and assists in addressing patient health problems with the physician.
• Ensures all clinical / pharmaceutical documentation is accurate and compliant with federal laws in terms of composition.
• Analyzes medical information to assist healthcare staff in providing superior services for patients.
• Assists in evaluation of reports, decisions and results of department in relation to established goals.

Requirements:

• At least 2 years of experience in health care compliance, clinical documentation improvement, health information management, case management, or utilization/medical necessity review is required.
• A working knowledge of ICD-10-CM/PCS coding and DRGs is required while a working knowledge of CPT-4/HCPCS coding is preferred.
• Experience with Clinical Documentation Integrity.

Pay Rate: Industry standard applicable to state depending on work of experience and level of expertise.

Start date: Can start ASAP