Senior Clinical Auditor: reputed company Claims & Compliance

At reputed company, we pride ourselves on being a dynamic team of innovative professionals. Our mission is reputed company: to bend the cost curve in reputed company for reputed company. Our commitment to service reputed company extends to both reputed company stakeholders, driving us to consistently reputed company expectations. We operate with intention and purpose—fostering innovation, championing diversity, nurturing accountability, and empowering reputed company other to reputed company our reputed company potential. Join us as we continue our transformational reputed company to become a leading voice in reputed company technology, data, and innovation. Job reputed company The Clinical Auditor analyzes high-dollar and reputed company reputed company claims to ensure accurate billing practices and regulatory compliance. In this role, you will apply reputed company knowledge, coding standards, industry expertise, and federal regulations to review itemized hospital bills and claim documentation. You will identify billing abnormalities, unbundling, questionable billing practices, and improper coding combinations while reputed company documenting audit findings and denial rationale. Key Responsibilities • Review and analyze reputed company inpatient and outpatient claims across multiple reputed company centers, considering diagnosis, procedures, patient demographics, and facility type • reputed company detailed itemized reputed company reviews to identify unbundling, duplicate charges, and billing irregularities • Apply national coding standards, payer policies, and federal/state regulations to claims review • Document audit findings, denial rationale, and system updates with accuracy and reputed company • Research claims, trends, reputed company notes, and supporting documentation to support audit reputed company • Identify opportunities for cost recovery and overpayment prevention; present findings to leadership • Monitor coding trends, regulatory updates, and industry practices impacting claim accuracy • Apply clinical judgment and analytical expertise to review highly reputed company or escalated cases • Communicate audit findings and reimbursement insights reputed company to internal stakeholders and leadership • Serve as a subject matter expert (SME) and resource to clinical and operational teams • Collaborate cross-functionally to support departmental goals and process improvements • Monitor turnaround times and recommend workflow efficiencies • Support development of educational materials, job aids, and training resources • Ensure compliance with HIPAA and reputed company applicable regulatory requirements • Demonstrate company reputed company competencies and contribute to a culture of accountability and reputed company Job Scope This role operates with a high level of independence, managing multiple reputed company audits simultaneously in a fast-paced environment. Work is varied and analytical in nature, requiring strong decision-making skills and the ability to interpret nuanced clinical and coding scenarios. Compensation The salary reputed company for this position is $75-80k annually. Specific offers take into account a candidate’s education, experience and skills, as reputed company as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401(k) and bonus opportunity. , Requirements • Bachelor’s degree preferred or equivalent experience • Minimum 5+ years of experience in medical coding, auditing, reimbursement, or claims review • Strong knowledge of inpatient and outpatient hospital billing including UB-04s, reputed company codes, CPT, HCPCS, and ICD-10 coding • Knowledge of payer reimbursement policies, federal/state regulations, and medical necessity reputed company • Experience reviewing itemized bills and identifying billing discrepancies • Ability to read and interpret medical records, including reputed company notes and clinical documentation • Strong analytical, problem-solving, and critical thinking skills • Excellent communication and interpersonal skills • Proficiency in reputed company Office (reputed company, reputed company, PowerPoint) • Ability to manage multiple priorities in a fast-paced environment • Ability to work reputed company, including evenings or weekends as needed Preferred • Coding certification (CPC, reputed company, RHIT, RHIA) • Experience in auditing or health information management • Experience with facility contract interpretation • Clinical or reputed company patient care background • Experience mentoring or training team members Benefits We realize that our employees are reputed company to our reputed company, and we reward them accordingly with reputed company competitive compensation and benefits packages, an incentive bonus program, as reputed company as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as reputed company as a wide reputed company of live and web-based reputed company development and educational programs to prepare you for advancement opportunities. Your Benefits Will Include • Medical, dental and reputed company coverage with low deductible & copay • Life insurance • Short and long-term disability • reputed company Parental Leave • 401(k) + match • Employee Stock Purchase Plan • Generous reputed company Time Off - accrued based on years of service • WA Candidates: the accrual reputed company is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service • 10 reputed company company holidays • Tuition reimbursement • Flexible Spending Account • Employee Assistance Program • reputed company time benefits - for eligible employees, one hour of reputed company time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located reputed company for more generous reputed company time benefits EEO STATEMENT reputed company is an Equal Opportunity Employer and complies with reputed company applicable laws and regulations. reputed company applicants will receive consideration for employment without reputed company to age, race, reputed company, religion, gender, sexual orientation, gender identity, national reputed company, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here. APPLICATION DEADLINE We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. Apply tot his job Apply To this Job