Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor.

Key Responsibilities

• Review and analyze complex inpatient and outpatient charges, identifying billing abnormalities and improper coding
• Document audit results, assist management in operations, and identify recovery opportunities
• Apply national coding standards to claims and communicate findings to co-workers and management

Required Qualifications

• Bachelor's degree preferred with at least 5 years of coding experience
• Minimum 5 years experience in medical procedure billing, auditing, or reimbursement
• Extensive knowledge of inpatient/outpatient hospital billing and coding standards
• Experience with payer reimbursement policies and medical necessity criteria
• Proficiency in MS Office Suites, particularly Excel, Outlook, and PowerPoint