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