CPC Certified Claims Auditor

Job Summary

A company is looking for a Claims Solution Professional Auditor.

Key Responsibilities

• Audit and monitor professional documentation and coding practices of healthcare providers and staff
• Validate charges entered by clinicians and assist with coding setup and training for new providers
• Perform audits and provide analysis of claims denials and payment issues to improve operational performance

Required Qualifications

• CPC Coding certification through AAPC or equivalent (e.g., CCS-P or DIP)
• Professional coding experience or medical billing experience
• CPMA auditor certification or equivalent is preferred
• Advanced coding knowledge (e.g., CCI edits, appeal management) is preferred
• Training in continuous improvement theory and application is preferred