. Summary The Medical Claims Auditor is responsible for reviewing and analyzing medical claims to ensure accuracy, compliance..., and adherence to company and regulatory standards. This role involves auditing provider-submitted claims, validating coding accuracy...
. Summary The Medical Claims Auditor is responsible for reviewing and analyzing medical claims to ensure accuracy, compliance..., and adherence to company and regulatory standards. This role involves auditing provider-submitted claims, validating coding accuracy...
& RESPONSIBILITIES: The Clinical Auditor will review medical records to determine accuracy of billing through verification of coding...Description : The Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation...
. Additional Information: The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality... metrics are met by conducting post claims reviews on posted claims for Texas Medicaid and CHIP programs. The Claim Auditor...
and commercial payer policy in written and verbal format Strong understanding of claims processing, ICD-10 Coding, DRG Validation...
. Support annual audits by providing required documentation and responding to auditor inquiries. Maintain organized electronic... to ensure correct expense coding and accurate financial reporting. Identify opportunities to improve processes and workflows...
with Coding Auditor sampling requirements. Maintain proficiency in VA systems and references: Veterans Health Information...: process record coding within seven (7) calendar days and sustain ≥95% accuracy for Current Procedural Terminology (CPT...
proper coding of revenues/expenses across programs, grants, and cost centers Partner with internal bookkeeping/AP/AR staff..., and proper coding of costs Provide financial guidance to program leaders (non-finance staff) on budgets, spending, and billing...
Specialists (NAMAS) Certified Evaluation and Management Auditor (CEMA) Coding Test - employees must achieve a minimum 70% passing... and AFMS MCPO instructions and timelines Adheres to accepted coding practices, guidelines, and conventions when choosing the...
with the Coding Supervisor/auditor during audit process. Ensures all required component parts of the medical record... and supports coding assignments. Educates MTF staff through individual or group in-services and training sessions. Maintains...
must illustrate the amount of actual medical coding work performed. Additionally, resume must indicate the minimum amount of education... Quality, Group Practice Managers, or other MTF business functions in compiling, analyzing, and reporting MTF coding data...
information from within internal · or other departments Responsible to send AEOS RQs to Coding as needed for clarification... for adjustment Notify management team of accounts that denied due to lack of medical necessity, etc, to be assigned nurse auditor...
and others as needed. Assist with external and internal auditors; preparing schedules as assigned and providing support for auditor selections... statement variance analysis in accordance with pre-defined scopes. Ensure accurate coding of transactions in accordance...
, including reviewing invoice submissions and coding, entering credit memos, and clearing old accounts Processes expense reports... (financial and process, written and verbal) to the applicable external auditor for testing and compliance analysis Ensure...
and resolving variances while maintaining audit-ready documentation. Review and approve invoice coding for the corporate office... to auditor inquiries, ensuring timely and accurate support for external and internal audits. Contribute to system and process...
. Experience in software requirements development. Software design and coding (C/C++, Ada, or other embedded programming.... Must quickly come up to speed with the software process auditor work scope, technical requirements, program risks, and delivery...