State Licensed Senior Auditor

Job Summary

To support the Clinical Chart Validation team, the full-time State Licensed Senior Auditor will defend recovery determinations by reviewing claims and documentation, applying relevant guidelines, and providing accurate written responses to appeals while working remotely.

Key responsibilities

• Utilizes available tools to evaluate appeals and applies appropriate policies to deliver accurate decisions
• Constructs factual and grammatically correct responses to providers regarding claim determinations
• Provides educational feedback to the audit and QA teams based on appeal reviews

Required qualifications

• Associates or Bachelor's degree in Nursing or Health Information Management (RHIA or RHIT) or equivalent experience in claims auditing
• Coding certification (RHIA, RHIT, CCS, or CIC) required; CCDS or CPC candidates must obtain inpatient coding certification within one year
• 5 to 7+ years of experience with ICD-9/10CM, MS-DRG, and medical claims billing/payment systems
• 3-5 years of medical record auditing or similar experience
• Proficiency in Word, Access, Excel, and other relevant applications