Texas Licensed Clinical Auditor

A company is looking for a Clinical Review Auditor.

Key Responsibilities

Review medical records for accuracy in billing and coding

Conduct audits to ensure accurate reimbursement and identify potential savings

Assist Quality Control team and medical director with appeals and notify leadership of any issues

Required Qualifications, Training, and Education

LVN or RN license in the state of employment preferred

CCS or CIC certification required with DRG auditing experience in ICD-10-CM and ICD-10 PCS

Experience in the OR, ICU, or ER as an RN highly preferred

Proficient understanding of Medicare, CMS guidelines, and ICD-10 coding guidelines

Knowledge of HIPAA Privacy and Security Rules