Certified Clinical Auditor

Job Summary

A company is looking for a Clinical Auditor - Outpatient.

Key Responsibilities

• Perform clinical reviews of claims against medical records to assess support for claims
• Maintain productivity and accuracy standards while documenting business operations and procedures
• Investigate claims and ensure compliance with state and federal policies

Required Qualifications

• High School Diploma/GED
• 2+ years of experience in claims auditing in an outpatient setting
• Knowledge of CMS and AMA coding rules (ICD-10, CPT, HCPCS)
• Experience with medical record coding and billing techniques
• Certified Outpatient Coder (COC), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) with COC within six months