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Clinical Validation Auditor
Job Summary
A developer of payment processing products is looking for a Clinical Validation Auditor.
Position Responsibilities
- Conduct clinical chart validation audits focusing on Place of Service, Short Stay and Readmission audits
- Review medical records for coding accuracy, medical necessity, and appropriateness of treatment
- Identify potential claims outside of the audit concept where additional recoveries may be available and suggest and develop high-quality concepts for process improvement
Required Qualifications:
Required Qualifications
- Associate's or Bachelor's degree in Nursing with an active/unrestricted license
- High level of proficiency in Milliman and Interqual guidelines, as well as the CMS inpatient only list
- Requires working knowledge of and applicable industry based standards
- ProficiencyinWord, Access, Excel and other applications
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COMPLETE JOB DESCRIPTION
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