Outpatient Coding Appeals Auditor

Job Summary

A company is looking for a Medical Review Coding Appeals Auditor (Outpatient).

Key Responsibilities

• Conducts Appeals reviews on medical review audit findings and documents results accurately
• Performs outpatient coding reviews and provides training opportunities or enhancements
• Monitors and reports on audit activities, contributing to continuous improvement initiatives

Required Qualifications

• Current certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
• 3+ years of direct experience in medical chart review for outpatient claims
• 5+ years of relevant auditing experience in a provider or payer environment
• Prior experience in primary audit or quality assurance functions
• Familiarity with payer edit development and reimbursement policy preferred