Clinical Auditor RN

Job Summary

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

Key Responsibilities

• Conducts audits of outpatient and specialty claims using medical chart coding principles and client-specific guidelines
• Utilizes advanced coding expertise and audit tools to ensure accuracy and compliance in claim assessments
• Identifies new claim types and recommends 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, or 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