Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor to analyze healthcare claims for billing accuracy and regulatory compliance.

Key Responsibilities

• Review and analyze complex inpatient and outpatient claims across multiple revenue centers
• Perform detailed itemized bill reviews to identify unbundling, duplicate charges, and billing irregularities
• Document audit findings and denial rationale while supporting audit decisions with research

Required Qualifications

• Bachelor's degree preferred or equivalent experience
• Minimum 5+ years of experience in medical coding, auditing, reimbursement, or claims review
• Strong knowledge of inpatient and outpatient hospital billing, including coding systems
• Ability to read and interpret medical records and clinical documentation
• Proficiency in Microsoft Office (Excel, Outlook, PowerPoint)