Clinical Auditor RN
A company is looking for an Auditor Clinical Validation Outpatient Specialty Clinical. Key Responsibilities Audit outpatient and specialty claims using medical chart coding principles and client-specific guidelines Utilize advanced audit tools and maintain productivity, accuracy, and quality standards Identify new claim types and recommend improvements to audit processes and concepts Required Qualifications Associate or bachelor's degree in nursing with an active/unrestricted license Coding certification required (e.g., CPC, CIC, CCS, CCS-P, RHIA, or RHIT) 5 to 7 years of experience in clinical medical record coding or auditing Knowledge of HIPAA Privacy and Security Rules and medical claims billing/payment systems Expert knowledge of coding guidelines and compliance mandates (e.g., DRG, ICD-10, CPT, HCPCS)
A company is looking for an Auditor Clinical Validation Outpatient Specialty Clinical.
Key Responsibilities
Audit outpatient and specialty claims using medical chart coding principles and client-specific guidelines
Utilize advanced audit tools and maintain productivity, accuracy, and quality standards
Identify new claim types and recommend improvements to audit processes and concepts
Required Qualifications
Associate or bachelor's degree in nursing with an active/unrestricted license
Coding certification required (e.g., CPC, CIC, CCS, CCS-P, RHIA, or RHIT)
5 to 7 years of experience in clinical medical record coding or auditing
Knowledge of HIPAA Privacy and Security Rules and medical claims billing/payment systems
Expert knowledge of coding guidelines and compliance mandates (e.g., DRG, ICD-10, CPT, HCPCS)
