Payment Integrity Auditor

Job Summary

A company is looking for a Payment Integrity Auditor to ensure accurate claims payment and uphold compliance through detailed chart reviews.

Key Responsibilities

• Perform medical chart reviews to ensure adherence to billing and payment policies
• Review inpatient charts for DRG assignment validation based on coding guidelines
• Collaborate with providers to resolve audit disputes and maintain audit documentation

Required Qualifications

• Bachelor's degree in a health care-related field or business-related discipline preferred
• Current credentials of CPC, RN, or RHIT/RHIA/CCS
• Strong knowledge of medical terminology and ICD-10-CM/PCS coding guidelines
• Inpatient Medical Chart Review experience is required
• Understanding of Inpatient and Outpatient Prospective Payment System regulations