Senior Clinical Auditor

Job Summary

A company is looking for a Senior Clinical Auditor.

Key Responsibilities

• Review and analyze complex inpatient and outpatient charges to ensure accurate billing practices
• Ensure compliance with HIPAA regulations and monitor coding trends and regulatory updates
• Provide guidance and training on clinical and coding issues to internal teams and staff

Required Qualifications

• High school diploma and 5+ years of line-item bill review experience, or completion of medical license or coding certification
• Extensive knowledge of inpatient and outpatient hospital billing, including UB-04 forms and coding systems
• Strong medical knowledge to identify inappropriate or questionable charges
• Knowledge of DRG and APC reimbursement methodologies
• Experience reviewing medical records and claim documentation