Outpatient Auditor

US-MA-Woburn
2 months ago
Job ID
2017-1014
# of Openings
1
Category
Auditor

Overview

A leader and innovator in healthcare cost containment, OmniClaim is a rapidly-growing company that provides a wide range of pre- and post-payment cost containment services designed to ensure that its insurance company clients are not overpaying on claims. As the industry leader in healthcare cost containment, the company’s disciplined approach, state of the art predictive analytics software, and fanatical focus on customer service are saving healthcare payers millions of dollars every month. We offer an entrepreneurial, high energy work environment, very competitive salaries and benefits commensurate with experience and an on-site café and workout facility.

Responsibilities

The Outpatient Auditor is responsible for performing an in-depth review of select outpatient medical records to ensure that the assigned codes are supported by clinical documentation and procedures are appropriately coded within appropriate guidelines.  You will be responsible for crafting and delivering appropriate, well-supported, and thoroughly-documented decisions on paid claims.  The Auditor will work collaboratively as part of elite team of auditors, schedulers, office support and management, supporting and learning from each other.

Qualifications

  • CCS, CPC or equivalent certification, RN, RHIA or RHIT preferred.
  • 5-10 years extensive experience coding in a tertiary outpatient hospital setting, and must exhibit advanced knowledge in ICD-10 and CPT /HCPCS coding.
  • Broad knowledge of CPT coding
  • Thorough understanding of 3M Encoder/grouper logic or similar billing software products is essential.
  • Demonstrated competence in APC payment classification. 
  • Working knowledge of HOPPS regulations.
  • Experience defending insurance company hospital outpatient coding denials 
  • Coding auditing experience a plus. 
  • Excellent oral and written communication, organizational and time management skills 
  • Ability to develop relationships at all levels
  • Ability to travel locally, regionally or nationally to different client sites. 

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed