Clinical Coding Auditor
Ann Arbor, Michigan
Supports our Client’s Health audit and payment integrity team primarily by auditing medical charts and records for compliance with applicable federal and state laws, regulation coding requirements, and industry guidelines in connection with claims audits or fraud/waste/abuse investigations.
- Audit medical records for required documentation and clinical support in accordance with CMS requirements for Risk Adjustment Data Validation (RADV) audits.
- Research, analyze, and respond to audit inquiries including, but not limited to, claim review as well as medical record review.
- Interact with management to review audit findings and prepare reports of findings.
- Ensure strict confidentiality of patient and financial records.
- Maintain certifications through conferences and workshops to obtain updated coding information and relevant changes in regulations and/or coding requirements.
- Bachelor’s Degree in Health Administration, Nursing, or related field, or equivalent experience.
- Certified Professional Coder (CPC) as certified by either the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).
- Three years’ successful experience in a clinical coding auditing role.
- Knowledge of healthcare claims auditing concepts and principles.
- In-depth knowledge of healthcare coding methods (e.g., CPT4, HCPCS, DRG, ICD-9, ICD-10, Revenue Codes) and medical terminology
- Proficient with healthcare claim adjudication standards and procedures (including application of benefit plan designs, administrative services agreements, coordination of benefits, and subrogation provisions), medical billing procedures, and regulatory requirements.
- Outstanding analytical, investigative, and organizational skills.
- Detail oriented with ability to manage multiple client assignments simultaneously.
- Excellent computer skills (Microsoft Word, Excel, Outlook).
- Excellent oral and written communication skills.
- Ability to work independently and as part of a productive audit team.