Medical Auditor

 In

Website Administrative

Reference Code: 4408

Position:  Medical Auditor
Duration: 10/26/2020 to 01/29/2021
Location Address: Albuquerque, NM, 87113

 

Description:

  • Function as a clinical reviewer for risk adjustment and Medicare Advantage risk adjustment audits to inspect clinical records for the presence of documentation to support the validity of claims data submitted.
  • Discern when missing medical record gaps exist and assist in directing request for additional records.
  • Some claims inspection/research is required.
  • Candidate must be able to work in a database environment and multiple PC apps simultaneously.
  • Experience with Microsoft products highly recommended.

Requirements:

  • RN or LPN required
  • Associates or Bachelor degree preferred
  • Experience in clinical auditing or medical record review preferred
  • Familiarity with claims investigation or research helpful
  • Awareness of claims processes and claims processing systems
  • Organizational skills and prioritization skills
  • Clear and concise verbal and written communication skills
  • Analytical skills
  • Ability to deal with internal and external customers, including Representatives and Providers
  • PC proficiency to include Microsoft Word and Excel and health insurance databases
  • This assignment is Monday – Friday, 40 hours per week. Daily work hours are flexible with management approval.

 

 

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