Clinical Auditor

4 days ago


Reston, Virginia, United States Medical Mutual Full time

Clinical Auditor Job Description

We are seeking a skilled Clinical Auditor to join our team at Medical Mutual. As a Clinical Auditor, you will be responsible for auditing complex outpatient, inpatient, and professional claim irregularities, overpayments, and provider appeals from a clinical coding perspective.

Key Responsibilities:

  • Audit outpatient, inpatient, and professional claims from a clinical and coding perspective, applying coding guidelines and edits.
  • Assess claims for inappropriate billing combinations, inherent charges, provider supporting documentation, and more.
  • Document audit results, including denial reasons and erroneous activities, and update systems accordingly.
  • Maintain knowledge of coding and billing guidelines and trends.
  • Review provider appeals, applying coding guidelines or edits.
  • Identify edits to adjudication systems that are not working properly or need to be installed.
  • Interact with internal or external auditors or vendors on claim coding updates and procedure changes.

Requirements:

  • Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor's Degree preferred.
  • In lieu of RN, Bachelor of Science in medical-related field.
  • 3+ years as a Clinical Auditor or equivalent combination of clinical and medical auditing experience.

Preferred Qualifications:

  • Certified Medical Auditor (if not certified, required to obtain within 18 months of hire).
  • Certified Coder preferred.

Technical Skills and Knowledge:

  • Knowledge of ICD codes.
  • Knowledge of procedure codes.
  • Knowledge of Revenue Codes, HCPC Codes, and CPT codes.
  • Knowledge of industry-standard billing rules and regulations for professional claims billing, outpatient claims billing, and inpatient claims billing.
  • Knowledge of insurance regulations.
  • Knowledge of coding and auditing techniques.
  • Good written communication skills.
  • Intermediate Microsoft Office and claims adjudications systems skills.

  • Clinical Auditor

    3 weeks ago


    Reston, Virginia, United States Medical Mutual Full time

    Clinical Auditor Job DescriptionWe are seeking a skilled Clinical Auditor to join our team at Medical Mutual. As a Clinical Auditor, you will be responsible for auditing complex outpatient, inpatient, and professional claim irregularities, overpayments, and provider appeals from a clinical coding perspective.Key Responsibilities:Audit claims for accuracy and...

  • Clinical Auditor

    4 weeks ago


    Reston, Virginia, United States Medical Mutual Full time

    Clinical Auditor Job DescriptionWe are seeking a skilled Clinical Auditor to join our team at Medical Mutual. As a Clinical Auditor, you will be responsible for auditing complex outpatient, inpatient, and professional claim irregularities, overpayments, and provider appeals from a clinical coding perspective.Key Responsibilities:Audit claims for accuracy and...

  • Clinical Auditor

    4 weeks ago


    Reston, Virginia, United States Medical Mutual Full time

    Clinical Auditor Job DescriptionWe are seeking a skilled Clinical Auditor to join our team at Medical Mutual. As a Clinical Auditor, you will be responsible for auditing complex outpatient, inpatient, and professional claim irregularities, overpayments, and provider appeals from a clinical coding perspective.Key Responsibilities:Audit claims for accuracy and...


  • Reston, Virginia, United States Medical Mutual Full time

    Clinical Auditor Job DescriptionAbout the RoleWe are seeking a highly skilled Clinical Auditor to join our team at Medical Mutual. As a Clinical Auditor, you will be responsible for auditing complex outpatient, inpatient, and professional claim irregularities, overpayments, and provider appeals from a clinical coding perspective.Key ResponsibilitiesAudit...


  • Reston, Virginia, United States Advanced Clinical Full time

    Manager of Clinical QualityLocation: Palo Alto areaHybrid - 3 days onsiteOverviewWe are currently seeking a skilled professional to join our team as a Manager, GCP Quality Assurance. This hybrid role will collaborate with cross-functional teams on deliverables and provide GCP and compliance-related advice to Internal Clinical Study teams. Your work will have...


  • Reston, Virginia, United States Advanced Clinical Full time

    Manager, Clinical Quality AssuranceLocation: Palo Alto areaHybrid - 3 days onsiteOverviewWe are seeking a skilled professional to join our team in San Francisco, California as a Manager, GCP Quality Assurance. This hybrid role will collaborate with cross-functional teams on deliverables and provide GCP and compliance-related advice to Internal Clinical Study...


  • Reston, Virginia, United States FUJIFILM Diosynth Biotechnologies Full time

    Job Title: Quality Assurance Supplier Lead AuditorAbout the Role:FUJIFILM Diosynth Biotechnologies is seeking a highly skilled Quality Assurance Supplier Lead Auditor to join our Global Supplier Quality Management team. As a key member of our team, you will be responsible for managing and leading Supplier auditors performing audits regionally and...


  • Reston, Virginia, United States GForce Life Sciences Full time

    Clinical Quality Specialist, GCP, Medical Device/PharmaceuticalsAbout the RoleGForce Life Sciences is seeking a Clinical Quality Specialist to support our client, a global medical device company, in ensuring compliance with GCP guidelines and international and national standards, regulations, and guidelines.Key ResponsibilitiesSupport general audit...


  • Reston, Virginia, United States Bayside Solutions Full time

    Clinical Quality Assurance RoleJob Summary:Bayside Solutions, Inc. is seeking a skilled Clinical Quality Assurance professional to support the quality assurance function in the pharmaceutical industry. As a Clinical Quality Assurance Contractor, you will play a key role in ensuring compliance with regulatory requirements and industry standards.Key...


  • Reston, Virginia, United States SciPro Full time

    SciPro Clinical Quality Assurance Manager Job DescriptionWe are seeking an experienced Clinical Quality Assurance Manager to join our team on a 6-12 month contract with high potential for conversion to permanent after the initial contract term. This will be a full-time, 40-hour per week position with 2-3 days required on-site.Our company is focused on...


  • Reston, Virginia, United States Bayside Solutions Full time

    Clinical Quality Assurance RoleBayside Solutions, Inc. is seeking a highly skilled Clinical Quality Assurance professional to join our team. As a key member of our quality assurance team, you will play a critical role in ensuring compliance with regulatory requirements and industry standards.Key Responsibilities:Collaborate with clinical functions to support...

  • Benefits Director

    3 weeks ago


    Reston, Virginia, United States Verisign Full time

    Job Title: Benefits DirectorVerisign is seeking a highly skilled Benefits Director to join our team. As a key member of our HR department, you will be responsible for designing, delivering, and administering domestic and international benefit plans that meet the diverse needs of our workforce.Key Responsibilities:Design and implement comprehensive benefit...


  • Reston, Virginia, United States VRS Recruitment (US) Full time

    Quality Assurance ManagerVRS Recruitment (US) is seeking a Quality Assurance Manager to oversee and manage quality control, quality assurance, and quality improvement within a contract research organization in New Hampshire.Key ResponsibilitiesEnsure regulatory compliance (e.g., GxP and CLIA) within the company and review and implement quality...


  • Reston, Virginia, United States VRS Recruitment (US) Full time

    Quality Assurance ManagerVRS Recruitment (US) is seeking a highly skilled Quality Assurance Manager to join our team in New Hampshire.Key ResponsibilitiesOversee and manage quality control, quality assurance, and quality improvement within the laboratory using electronic document systemsEnsure regulatory compliance (e.g., GxP and CLIA) within the company and...