Medical Review Coding Appeals Auditor – Outpatient
Job Description: • Conduct Appeals reviews of new evidence presented by auditees • Document Appeals results in accordance with department quality policies and procedures • Perform limited volume of outpatient coding reviews on medical records • Monitor, track, and report on all work conducted in accordance with Appeals process • Contribute to the continuous improvement feedback process • Maintain current knowledge and changes that affect our industry and clients • Consult with internal resources as necessary Requirements: • Current certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P • Must not be currently sanctioned or excluded from the Medicare program by OIG • 3+ years of direct experience in medical chart review for all provider/claim types for outpatient • 5+ years relevant auditing experience in a provider or payer environment • Prior experience in role with responsibility for conducting primary audit, utilization management or prior-authorization work • Familiarity with interpreting electronic medical records (EHR) • Strong knowledge of medical documentation requirements and understanding of CMS, Medicaid and/or Commercial insurance programs Benefits: • medical insurance • dental insurance • vision insurance • HSA/FSA options • life insurance • 401(k) savings plans • family/parental leave • paid holidays • paid time off annually Apply tot his job