Certified Medical Review Auditor

Job Summary

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