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Medical Review Auditor

Job Attributes

Job Id:

29648

Job Category:

Clinical & Life Sciences

Job Location:

Rockville, MD  20847

Security Clearance:

No Clearance

Business Unit:

Piper Companies

JOB DESCRIPTION

Piper Clinical Solutions is looking for a motivated Medical Review Auditor in Rockville, MD to support review and investigations of medical documentation and claims, specifically related to surgical procedures, to ensure appropriate coding rules and guidelines are being followed.

 

Responsibilities for the Medical Review Auditor:

  • Review of medical records and claims associated with surgical procedures
  • Use knowledge of healthcare coding conventions, known vulnerabilities, reimbursement methodologies, and relevant laws to identify patterns in claims, provider enrollment, and other data sources
  • Remain current on all coding changes
  • Perform proactive record review by applying knowledge of coding guidelines, medical procedures, medical policies, Medicare/Medicaid policies, etc.
  • Prepare extensive written reviews for submissions to customers, providers, and internal staff
  • Possible supervision of other members of the medical review team; providing guidance and direction to members of the team with less experience

 

Requirements for the Medical Review Auditor:

  • 2+ years of related experience in medical review
  • Certified Coder (CPC, CHC or other specialty coding certification)
  • Extensive knowledge of ICD9, ICD10, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, and Medicare  guidelines (including NCCI)
  • Strong understanding of surgical claims required
  • Other certifications a plus: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Accredited Healthcare Fraud Investigator (AHFI), and Certified Fraud Examiner (CFE)
  • Current RN (Registered Nurse) License
  • BSN or ASN Degree

 

Compensation for the Medical Review Auditor:

  • Salary up to $100,000 based on meeting of requirements
  • Benefits: Health, Dental, & Vision Insurance, 401K

 

Please send all qualified resumes to: dmanley@pipercompanies.com

 

Keywords

ICD9, ICD10, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, NCCI, priority partners, DoD, Tricare, Medicare, Medicaid, Utilization Review, UR, CPC, Certified Professional Coder, medical review, coding guidelines, interqual, milliman, program integrity, surgery, surgical

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Job Id:

29648

Job Category:

Clinical & Life Sciences

Job Location:

Rockville, MD  20847

Security Clearance:

No Clearance

Business Unit:

Piper Companies