Clinical Auditor Nurse

Job Summary

A company is looking for an Auditor Clinical Validation Outpatient Specialty Clinical.

Key Responsibilities

• Audit outpatient and specialty claims using medical chart coding principles and client-specific guidelines
• Utilize advanced coding expertise and audit tools to identify billing/coding issues and document audit results
• Recommend new concepts and processes to enhance audit production and client satisfaction

Required Qualifications

• Associate or bachelor's degree in nursing with an active/unrestricted license
• Coding certification required (e.g., CPC, CIC, CCS, CCS-P, RHIA, or RHIT)
• 5 to 7 years of experience in clinical medical record coding or auditing
• Knowledge of HIPAA Privacy and Security Rules and CMS security requirements
• Expert knowledge of coding guidelines, including DRG, ICD-10, CPT, and HCPCS codes