Clinical Auditor RN

Job Summary

A company is looking for an Auditor Clinical Validation Outpatient Specialty Clinical.

Key Responsibilities

• Audit outpatient and specialty claims using medical chart coding principles and client-specific guidelines
• Utilize advanced audit tools and ensure accurate entry of claims into the system
• Identify new claim types and recommend process improvements based on extensive healthcare auditing experience

Required Qualifications

• Associate or bachelor's degree in nursing with an active/unrestricted license
• Coding certification (e.g., CPC, CIC, CCS, CCS-P, RHIA, RHIT) required and maintained
• 5 to 7 years of experience in clinical medical record coding or auditing
• Broad knowledge of medical claims billing/payment systems and coding terminology
• Expert knowledge of coding guidelines, including DRG, ICD-10, CPT, and HCPCS codes