Clinical Auditor
3 weeks ago
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 claims for accuracy and compliance with coding guidelines and regulations.
- Identify and document denial reasons, erroneous activities, and other audit findings.
- Maintain knowledge of coding and billing guidelines, trends, and industry developments.
- Review provider appeals and identify opportunities for recovery and avoidance.
- Collaborate with internal and external auditors, vendors, and other stakeholders to ensure accurate and efficient claim processing.
Requirements:
- Graduate of a registered nursing program approved by the Ohio State Nursing Board. Bachelor's Degree preferred.
- 3+ years of experience as a Clinical Auditor or equivalent combination of clinical and medical auditing experience.
- Certified Medical Auditor (CMA) certification preferred.
Technical Skills:
- Knowledge of ICD codes, procedure codes, 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.
- Intermediate Microsoft Office and claims adjudications systems skills.
Why Join Us:
At Medical Mutual, we value our employees and offer a dynamic and supportive work environment. We are committed to providing excellent patient care and are seeking a skilled Clinical Auditor to join our team.
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