Clinical Auditor

Must-have

• Associates Degree in business, healthcare, or related field
• At least 3 years of analyzing coding-related denials (for problems such as bundling issues and inappropriate CPT/diagnoses) to identify trends and root causes.
• Strong knowledge of medical terminology, coding standards (ICD-10, CPT, HCPCS), and healthcare regulations.
• Experience developing process improvements for coding and documentation workflows based on denial analysis and industry coding guidelines.
• Current coding certification (CPC, CCS)

Plusses

• Bachelor's Degree in business, healthcare, or related field.

Day to day:

Insight Global is seeking 1 Clinical Auditor to support a large healthcare system based out of Annapolis, MD. The Clinical Auditor will play a crucial role in ensuring the accuracy and integrity of clinical documentation and billing processes within the Patient Financial Services department. This position involves conducting detailed audits of medical records, coding, and billing practices to ensure compliance with regulatory standards and internal policies. The Clinical Auditor will work closely with clinical staff, coders, and financial services personnel to identify discrepancies, provide education, and implement corrective actions.

Key Responsibilities:

• Analyzes coding-related denials (for problems such as bundling issues and inappropriate CPT/diagnoses) to identify trends and root causes.
• Develops process improvements for coding and documentation workflows based on denial analysis and industry coding guidelines.
• Conduct comprehensive audits of medical records to verify the accuracy of clinical documentation and coding.
• Review billing practices to ensure compliance with federal, state, and local regulations, as well as hospital policies.
• Identify and report discrepancies, errors, and potential areas of risk in clinical documentation and billing.
• Collaborate with clinical staff, coders, and financial services personnel to provide education and training on proper documentation and coding practices.
• Develop and implement corrective action plans to address identified issues and improve overall compliance.
• Prepare detailed audit reports and present findings to the Director of Patient Financial Services and other relevant stakeholders.
• Stay current with changes in healthcare regulations, coding standards, and best practices in clinical auditing.
• Assist in the development and maintenance of auditing policies and procedures.
• Participate in internal and external audits as required