Clinical Auditor

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The Clinical Auditor performs detailed audits of inpatient or outpatient medical accounts, comparing the medical record documentation with the itemized bill, nursing procedures, and department documented charging practices. The auditor coordinates and reports audit outcomes regarding charge errors, percentage of savings or losses for the faculty, data processing errors, the performance of the hospital charging system as well as documentation and justification within the medical record and itemized bill.

QUALIFICATIONS:

• Bachelor's degree in Nursing, health-related field, related field and a minimum of 2 years of related experience, or an equivalent combination of education and work experience
• Experience with PCs, word processing, spreadsheet, graphics, and database software applications are desired - previous auditing experience preferred
• Strong quantitative, analytical, interpersonal and communication skills
• Proficient in payment review systems, hospital information systems, clinical record information systems, and some coding methodologies
• Ability to understand and interpret medical records, hospital bills, and the charge master along with the ability to understand all ancillary department functions
• Ability to understand insurance terms (i.e. HMO/PPO, EOB, stop loss, etc.) and payment methodologies and to effectively negotiate with insurance carrier representatives and customers.
• Knowledge of regulatory agencies requirements (JCAHO, CMS & Medicaid) and remain current on new regulations, policies and procedures