Reference Code: 4408
Position: Medical Auditor
Duration: 10/26/2020 to 01/29/2021
Location Address: Albuquerque, NM, 87113
- 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.
- 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.