Medical Review Coding Appeals Auditor – Outpatient
Job Description:
• Conduct Appeals reviews of new evidence presented by auditees
• Document Appeals results in accordance with department quality policies and procedures
• Perform limited volume of outpatient coding reviews on medical records
• Monitor, track, and report on all work conducted in accordance with Appeals process
• Contribute to the continuous improvement feedback process
• Maintain current knowledge and changes that affect our industry and clients
• Consult with internal resources as necessary
Requirements:
• Current certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
• Must not be currently sanctioned or excluded from the Medicare program by OIG
• 3+ years of direct experience in medical chart review for all provider/claim types for outpatient
• 5+ years relevant auditing experience in a provider or payer environment
• Prior experience in role with responsibility for conducting primary audit, utilization management or prior-authorization work
• Familiarity with interpreting electronic medical records (EHR)
• Strong knowledge of medical documentation requirements and understanding of CMS, Medicaid and/or Commercial insurance programs
Benefits:
• medical insurance
• dental insurance
• vision insurance
• HSA/FSA options
• life insurance
• 401(k) savings plans
• family/parental leave
• paid holidays
• paid time off annually
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