Certified Medical Auditor

Job Summary

Conducting audits of medical records, the full-time Certified Medical 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 policies and regulations
• Prepare and submit detailed reports on audit findings, providing recommendations for improvements
• Research medical policies and relevant 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
• Proficiency in MS Office suite
• Understanding of ICD, CPT, HCPCS, and federal and state guidelines