Certified Medical Auditor (NC)

Job Summary

Working remotely full-time, a Certified Medical Auditor (NC) will perform validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events, while coordinating rate adjustments and providing reports on trends in medical records management.

Key responsibilities

• Conducts validation reviews and coordinates rate adjustments with claims areas, creating reports on outcomes and trends
• Manages records retrieval, release, and HIPAA compliance, overseeing all aspects of document management
• Acts as an expert resource for medical records and coding issues, providing guidance on methodology and procedures

Required qualifications

• Associate's degree in a job-related field or equivalent experience (2 years of job-related work experience)
• 3 years of experience in medical record management, including coding and validation review
• Registered health information administrator (RHIA), Registered health information technician (RHIT), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), Certified Professional Medical Auditor (CPMA), or active unrestricted RN licensure
• Extensive knowledge of medical records and coding practices, along with claims processing and adjudication
• Ability to handle confidential information with discretion and demonstrate good judgment