Remote Certified Auditor

Job Summary

Working remotely on a temporary basis, the Prospective Auditor will review claims data identified by a web-based AI tool, ensuring the accuracy and compliance of Medicare and Medicare Advantage claims before forwarding them for provider review.

Key responsibilities:

• Auditing claims and data for accuracy using the Innovaccer platform
• Reviewing documentation to support coding decisions and making final determinations on code specificity
• Managing a high volume of daily reviews, typically between 50 and 80 cases

Required qualifications:

• 1+ years of experience in risk adjustment coding, HCC coding, or outpatient diagnosis coding
• Active coding certification such as CPC, CRC, CPMA, CDEO, CCS, CCS-P, RHIA, RHIT, or CCDS
• Experience with daily review volumes of 50 to 80 cases using Innovaccer
• Proficiency with the 3M coding tool and electronic medical records like Epic, Athena, and Cerner
• Ability to work remotely in a dedicated environment