Pennsylvania Licensed 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 claims 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 or business-related field 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 regulatory requirements related to payment systems