Text copied to clipboard!
Title
Text copied to clipboard!Medical Auditor
Description
Text copied to clipboard!
We are looking for a detail-oriented and experienced Medical Auditor to join our healthcare compliance team. The ideal candidate will be responsible for reviewing medical records, billing data, and coding practices to ensure accuracy, compliance with regulations, and optimal reimbursement. This role is critical in maintaining the integrity of healthcare documentation and ensuring that healthcare providers adhere to established standards and policies.
As a Medical Auditor, you will conduct audits of clinical documentation and coding to assess the accuracy and completeness of medical records. You will also identify areas of risk, recommend corrective actions, and provide education and training to healthcare staff. Your work will support the organization's efforts to comply with federal and state regulations, including those set by Medicare, Medicaid, and private insurance companies.
You will collaborate closely with physicians, coders, billing specialists, and compliance officers to ensure that documentation supports the services billed and that coding is accurate and compliant. You will also assist in developing audit plans, preparing audit reports, and tracking the implementation of corrective actions.
The successful candidate will have a strong understanding of medical terminology, coding systems (ICD-10, CPT, HCPCS), and healthcare regulations. Certification as a Certified Professional Medical Auditor (CPMA) or similar credential is highly desirable. Strong analytical skills, attention to detail, and the ability to communicate findings effectively are essential for success in this role.
This position offers an opportunity to play a vital role in improving healthcare quality and compliance while working in a dynamic and supportive environment.
Responsibilities
Text copied to clipboard!- Conduct audits of medical records and billing data
- Ensure compliance with coding and documentation standards
- Identify discrepancies and recommend corrective actions
- Collaborate with healthcare providers and coders
- Prepare detailed audit reports and summaries
- Provide training and education on compliance issues
- Assist in developing and implementing audit plans
- Monitor corrective action implementation
- Stay updated on regulatory changes and industry standards
- Support internal and external audit processes
Requirements
Text copied to clipboard!- Bachelor’s degree in healthcare administration, nursing, or related field
- Certified Professional Medical Auditor (CPMA) or equivalent certification
- Minimum of 3 years of experience in medical auditing or coding
- Strong knowledge of ICD-10, CPT, and HCPCS coding systems
- Familiarity with healthcare regulations and payer requirements
- Excellent analytical and problem-solving skills
- Attention to detail and accuracy
- Strong written and verbal communication skills
- Ability to work independently and collaboratively
- Proficiency in Microsoft Office and auditing software
Potential interview questions
Text copied to clipboard!- Do you hold a CPMA or similar certification?
- How many years of experience do you have in medical auditing?
- Can you describe your experience with ICD-10 and CPT coding?
- Have you conducted compliance audits in a healthcare setting?
- What tools or software have you used for auditing?
- How do you stay current with changes in healthcare regulations?
- Describe a time you identified a major compliance issue.
- How do you handle disagreements with healthcare providers over audit findings?
- Are you comfortable providing training to clinical staff?
- What is your approach to preparing audit reports?
