Auditor Clinical Validation Outpatient Specialty Clinical

Responsibilities: Perform clinical and coding audits for outpatient and specialty claims to ensure accuracy, medical necessity, and appropriateness of treatment. Document audit results and suggest process improvements to enhance recovery and client satisfaction.

Requirements: Requires an active nursing license (Associate or Bachelor's) and a professional coding certification such as CPC, CIC, or CCS. Candidates must have 5 to 7 years of experience in clinical medical record coding or auditing.

Key skills: Clinical Chart Validation, Medical Coding, Outpatient Auditing, Medical Necessity Review, ICD-10, CPT, HCPCS, DRG, HIPAA Compliance, CMS Guidelines, Clinical Review, Medical Record Auditing

Keywords: Cotiviti Encoder, APC, PNPP, SNF, IRF, Home Health, ER, Diagnostics, Professional Service, CPC, CIC, CCS, CCS-P, RHIA, RHIT, HIPAA, CMS, ICD-10, CPT, HCPCS, DRG, Medical Billing, Payer Reimbursement, Clinical Validation, Healthcare Auditing