Medical Auditor

MaineHealth; Scarborough (ME); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a fully remote Medical Auditor to join its collaborative team. This role involves reviewing coding and medical necessity denials, ensuring compliance with regulations, and supporting appeals processes. The ideal candidate will have a Bachelor’s degree in Healthcare and relevant coding certifications, along with clinical experience. The organization is committed to fostering an inclusive environment and offers a range of benefits, including flexible work policies and student loan assistance. If you're passionate about healthcare and teamwork, this opportunity is perfect for you.

Benefits

Paid Parental Leave

Flexible Work Policies

Student Loan Assistance

Training and Education Resources

Well-being Resources

Qualifications

• Minimum three years of coding and/or clinical experience required.
• Bachelor’s Degree in Healthcare or related field is mandatory.
• CPC, COC, or other coding certification preferred.

Responsibilities

• Review and appeal various types of denials, including coding and medical necessity.
• Assess clinical documentation to support medical necessity for appeals.
• Research government regulations and payer policies for payment requests.

Skills

CPT Codes

HCPCS Codes

ICD Codes

Coding Certification (CPC, COC)

Clinical Experience

Nursing Credentials

Education

Bachelor’s Degree in Healthcare

Job description

Fully Remote Medical Auditor Position

The Medical Auditor will review and appeal various types of denials, including coding denials, MUE denials, and medical necessity denials. Responsibilities include assessing clinical documentation to support medical necessity for appeals or audits, and researching government regulations, payer policies, and contract terms to support payment requests for services rendered.

Our ideal candidate is an experienced certified coder with hospital revenue cycle experience. Clinical experience and nursing credentials are a plus.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: Bachelor’s Degree in Healthcare or a related field required.
2. License/Certifications: CPC, COC, or other coding certification preferred. Current licensure as a Registered Nurse preferred.
3. Experience: At least three years of coding and/or clinical experience required.
4. Additional Skills/Requirements: N/A
5. Preferred Skills: Knowledge of CPT, HCPCS, Revenue, and ICD codes; understanding of Medicare's LCD and NDC guidelines, appeals process, and timelines; familiarity with State and Federal regulations and third-party payers.

Additional Information

Join MaineHealth across Maine and New Hampshire, working with healthcare professionals who value collaboration within the organization and the community.

We offer benefits such as paid parental leave, flexible work policies, student loan assistance, training, education, and well-being resources for you and your family.

MaineHealth is committed to investing in our care team and fostering an inclusive environment where you can thrive. If you're interested in building a career where teamwork delivers top-quality care, apply today.

For questions about this role, contact Leanne M. Roberts at [e-mail].