Certified Medical Auditor

A company is looking for a Medical Auditor to review and appeal various types of denials related to medical services.

Key Responsibilities

Review and appeal coding, MUE, and medical necessity denials

Assess clinical documentation to support appeals and audits

Research government regulations, payer policies, and contract terms related to payment requests

Required Qualifications, Training, and Education

Bachelor's Degree in Healthcare or a related field

CPC, COC, or other coding certification preferred; current RN licensure preferred

Three years of coding and / or clinical experience required

Knowledge of CPT, HCPCS, Revenue, and ICD codes

Understanding of Medicare's medical necessity guidelines and appeals process