Senior Auditor, Clinical Coding

Job Summary

A company is looking for a Senior Auditor, Clinical Coding Review.

Key Responsibilities

• Lead prospective claim review audits related to clinical DRG coding compliance and high dollar claim reviews
• Ensure payment integrity programs comply with internal and Medicare guidelines
• Act as Subject Matter Expert to counsel team members on clinical coding guidelines and support cross-functional collaboration

Required Qualifications

• CCS or CIC certification (required)
• Current or previous nursing experience or CDI certification (required)
• Previous experience in the insurance industry
• Deep understanding of CMS rules and regulations
• Strong computer skills in Access, Excel, Visio, and PowerPoint; knowledge of SQL is a plus