Texas Licensed Clinical Auditor

A company is looking for a Clinical Review Auditor.

Key Responsibilities

Review medical records to determine accuracy of billing through verification of coding and supporting documentation

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 in a timely manner

Required Qualifications, Training, and Education

Current LVN or RN license in the state of employment, maintained during employment

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 is highly preferred

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

Working knowledge of HIPAA Privacy and Security Rules