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 appeals, applying relevant guidelines, and constructing detailed responses to providers while working remotely.

Key responsibilities

• Utilizes available tools and resources to evaluate each appeal and deliver accurate decisions
• Constructs factual, reference-supported, and professionally written responses to providers regarding claim determinations
• Provides educational feedback to the audit and QA teams based on appeal reviews and maintains productivity standards

Required qualifications

• Associate's or Bachelor's degree in Nursing or Health Information Management (RHIA or RHIT) or equivalent experience of 5+ years in claims auditing
• Coding Certification (RHIA, RHIT, CCS, or CIC preferred; 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 with adherence to coding guidelines and compliance
• Proficiency in Word, Access, Excel, and other applications relevant to the role