Sr Auditor Tl, Clinical Validation

Judge Healthcare is seeking a Sr. Coding & Clinical Chart Validation (Inpatient) Auditor!!

Employment Type :  Temp to Hire

Location :  Fully Remote

Training Hours :  8 : 00 AM – 4 : 00 PM EST

Work Hours :  Full Time, 40 hrs.' per week in between 6a-6p EST

We are seeking an experienced Auditing Specialist to focus on Coding & Clinical Chart Validation for our Inpatient Audits. The ideal candidate possesses a combination of clinical expertise (nursing) and / or coding / auditing experience, particularly in Inpatient DRG / APR-DRG and episode of care disciplines. This role involves auditing inpatient claims and documenting results, with an emphasis on clinical review, coding accuracy, and evaluating treatment settings and services.

Key Responsibilities

• Claims Analysis and Auditing (Primary Role)
• Conduct medical chart coding reviews and audits, leveraging advanced ICD-10 coding principles, clinical guidelines, and industry knowledge.
• Perform comprehensive reviews of medical records and episodes of care independently.
• Effective Use of Audit Tools
• Utilize proprietary auditing systems to generate audit determinations and documentation.
• Demonstrate a high level of proficiency in audit tools.
• Meet Standards of Productivity
• Achieve and maintain production goals set by the audit operations team.
• Maintain Accuracy and Quality
• Ensure adherence to accuracy and quality benchmarks for auditing, claim validation, and documentation.
• Discover New Opportunities
• Identify claims outside of predefined concepts for potential recovery opportunities.
• Develop high-value concepts, process improvements, and innovative tools.
• Complete Assigned Duties
• Fulfill responsibilities outlined in the annual performance plan and contribute to special projects as needed.

Requirements

Education At least one of the following :

Certifications At least one of the following :

Experience