Certified Medical Auditor
- Full-time
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
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Auditor • Greenville, South Carolina, United States