Medical Auditor

Description

Fully Remote working position

The Medical Auditor role will work on reviewing and appealing multiple types of denials, including coding denials, MUE denials, and medical necessity denials. Assesses clinical documentation for supporting medical necessity to appeal denials or audits, and researches various government regulatory and sub-regulatory guidance, payer policies, and contract terms to support our request for payment on services rendered. Our ideal candidate is an experienced certified coder with hospital revenue cycle experience. Clinical experience and nursing credentials are a plus.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: Bachelor's Degree in Healthcare and/or related field required.
2. License/Certifications: CPC, COC or other coding certification preferred. Current licensure as a Registered Nurse preferred.
3. Experience: Three years of coding and/or clinical experience required.
4. Additional Skills/Requirements Required: N/A
5. Additional Skills/Requirements Preferred: Current knowledge of CPT, HCPCS, Revenue and ICD codes. Current knowledge of the rules and regulations as they relate to State and Federal Government and 3rd Party Payers. In-depth understanding of Medicare's LCD and NDC medical necessity guidelines, appeals process and timelines.

If you have questions about this role, please contact Leanne M. Roberts at leanne.roberts@mainehealth.org