Medical Auditor

This role will apply technical and specialized expertise to help risk adjusted organizations remain compliant while identifying opportunities for increased financial success.

This Remote position performs highly technical and specialized functions. The primary function of the Medical Auditor is to perform a review of patient encounters to assess for completeness and accuracy of provider documentation, along with correct ICD-10 code assignment. Additionally, the Medical Auditor will work remotely, assisting clients to maintain compliance through completion of focused chart audits, ensuring compliance with established coding guidelines, third party reimbursement policies, regulations, and accreditation guidelines.

• →Perform clinical validation audits and interpretation of medical documentation to ensure capture of patient conditions in compliance with coding guideline
• →Performs reviews for prospective audits, retrospective audits, and RADV audits when requested by client.
• →Integrates coding principles in performance of medical audit activity and educates as needed on those principles
• →Upon completion of medical record audit, compiles detailed findings and prepares client reports.
• →Reviews medical record audit results with the client on a monthly or as needed basis.
• →Provides feedback and process improvement recommendations to Client Service Liaison regarding assigned clients and participates in workgroups/committee meetings and process improvement solutions as required.
• →Advises Client Service Liaison of possible trends in inappropriate utilization.
• →Maintains professional license and certifications. Attends training conferences and webinars, as necessary to keep abreast of latest trends in ICD-10 coding.
• →Reviews bulletins, newsletters and periodicals and attends workshops to stay abreast of current issues, trends and changes in the laws and regulations governing medical ICD-10 CM coding and documentation.
• →Understands and adheres to the Health Insurance Portability and Accountability Adt (HIPPA) requirements
• →Participates as requested in department meetings, client calls and annual performance evaluation
• →Embody AnewHealth’s Core Values in all communications and interactions.
• →Other duties as assigned.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job.  Not all of the duties may be assigned to a position.

• Required: Professional Medical Coder Certification, one or more of the following:
  • Certified Coding Specialist designation (CCS) issued by the American health Information Management Association
  • Certified Professional Coder (CPC)
  • Technologist (RHIT) with 6 months experience coding ICD-10 CM

• Preferred:
  • CRC certification, CPMA

• Experience in Clinical documentation improvement.
• Experience in Hierarchical Condition Categories (HCC).
• Knowledge of or experience in Medicare Advantage plans.
• Knowledge of or experience in managed health care systems, PACE or Medicare.
• Must have experience with MS Word, Excel, PowerPoint and comfortable with learning and becoming an expert on new and proprietary software.