PRINCIPLE PURPOSE OF JOB:
We are currently seeking Auditor to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Auditor is responsible for analyzing and interpreting and assign the correct codes for the descriptions available on various medical procedures and diagnosis and other related medical coding as per the medical policy requirements.
JOB RESPONSIBILITIES:
- Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement
- Respond to provider appeals
- Respond to client logics and record reviews
- Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations
- Reports his/her work performance on a timely basis to the team lead
- Works diligently to meet and exceed productivity and quality benchmarks
- Takes charge of ongoing learning and development and participates in relevant training and development activities
- Willing to work in US hours during training, which may last for 8 to 12 weeks. Thereafter shift timing will overlap US working hours for couple of hours based on business requirements.
- Required to work from office
- Works effectively in co-ordination with the India team
RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS:
Active nursing license is mandatory; Medical coders with CIC or CCS certification with prior DRG experience (at least 1-2 years experience)
- Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred
- Possesses knowledge of healthcare claims payment policy and processing specifically CMS, Medicaid regulations, ICD-10 CM & DRG Expert, etc
- Has general knowledge of medical procedures, conditions, illnesses, and
- treatment practices
- Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency
- Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.
