Medical Auditor, ME
50768 Description Fully Remote working position The Medical Auditor role will work on reviewing and appealing multiple types of denials, including coding denials, MUE denials, and medical necessity denials. Assesses clinical documentation for supporting medical necessity to appeal denials or audits, and researches various government regulatory and sub-regulatory guidance, payer policies, and contract terms to support our request for payment on services rendered. Our ideal candidate is an experienced certified coder with hospital revenue cycle experience. Clinical experience and nursing credentials are a plus. Required Minimum Knowledge, Skills, and Abilities (KSAs) • Education: Bachelor’s Degree in Healthcare and/or related field required. • License/Certifications: CPC, COC or other coding certification preferred. Current licensure as a Registered Nurse preferred. • Experience: Three years of coding and/or clinical experience required. • Additional Skills/Requirements Required: N/A • Additional Skills/Requirements Preferred: Current knowledge of CPT, HCPCS, Revenue and ICD codes. Current knowledge of the rules and regulations as they relate to State and Federal Government and 3rd Party Payers. In-depth understanding of Medicare's LCD and NDC medical necessity guidelines, appeals process and timelines. Additional Information With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it. We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family. MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today. If you have questions about this role, please contact Leanne M. Roberts at [email protected] Apply tot his job