Job Details

A company is looking for an Auditor Clinical Validation Outpatient Specialty Clinical.Key ResponsibilitiesAudit outpatient and specialty claims using medical chart coding principles and client-specific guidelinesUtilize advanced audit tools and maintain productivity and quality standardsIdentify new claim types and recommend improvements to enhance audit processesRequired QualificationsAssociate or bachelor's degree in nursing with an active/unrestricted licenseCoding certification (e.g., CPC, CIC, CCS) required and maintained5 to 7 years of experience in clinical medical record coding or auditingKnowledge of HIPAA Privacy and Security Rules and medical claims billing systemsExpert knowledge of coding guidelines, including DRG, ICD-10, CPT, and HCPCS codes