Texas Licensed Clinical Auditor

Job Summary

A company is looking for a Clinical Review Auditor.

Key Responsibilities

• Review medical records for accuracy of billing and coding
• Conduct audits to ensure accurate reimbursement and identify potential savings
• Assist Quality Control team and medical director with appeals and notify leadership of any issues

Required Qualifications, Training, and Education

• LVN or RN license in the state of employment preferred
• CCS or CIC certification required with DRG auditing experience in ICD-10-CM and ICD-10 PCS
• Experience in the OR, ICU, or ER as an RN is highly preferred
• Proficient understanding of Medicare, CMS guidelines, and ICD-10 coding guidelines
• Knowledge of HIPAA Privacy and Security Rules