Medical Record Auditor

Healthcare Support Staffing; New York (NY); On-site; USD 80,000 - 120,000; Full time

Benefits offered by this job

Medical, Dental, and Vision benefits

Fun and positive work environment

Fun and positive work environment

Monday–Friday 8am–5pm

Job summary

A healthcare service provider in New York seeks a Medical Auditing Associate to conduct Medical Records reviews and evaluations ensuring compliance with CMS guidelines. This role requires a Bachelor’s degree, relevant certification, and at least 5 years of coding or auditing experience. Competitive, negotiable salary with full benefits is offered, fostering a supportive work environment. This full-time position operates Monday to Friday with 8am-5pm hours.

Qualifications

• Bachelor's Degree in a relevant field is required.
• Certification in medical auditing is necessary.
• 5+ years of relevant coding or auditing experience required.
• Experience developing educational materials and delivering trainings related to ICD-9 coding.

Responsibilities

• Conduct Medical Records reviews to identify unsubmitted HCCs.
• Evaluate and audit medical records to ensure compliance.
• Provide feedback on performance improvement opportunities.
• Act as subject matter expert in CMS requirements and practices.
• Participate in business leadership and professional groups.

Skills

ICD-9 coding experience

Medical record auditing

Training development

Data analysis

Education

Bachelor’s Degree in Health Sciences, Health Management, or Nursing

CPC or CPMA certification

Job description

With a 16-year tradition of excellence. A single source provider of world-class technology products and services for the healthcare industry. We are at the forefront of delivering cutting-edge, scalable technologies and solutions that respond to and anticipate the market's needs while providing sustainable value to our customers. Healthcare is our only business, giving us an unparalleled understanding of the volatile healthcare landscape. We take great pride in maintaining the highest levels of client satisfaction for the hundreds of U.S. hospitals and healthcare providers we serve. Our innovative products and services empower our customers to do what they do best – deliver outstanding patient care.

Job Description

Associate would be in charge of conducting Medical Records reviews to identify
HCCs (short-term insurance) that still haven't been submitted to CMS
(tools provided by the department). Collect the medical records that
support those findings upload in to our tool and code it.

Evaluates
and audits physician and hospital medical records and medical assessment
forms to ensure compliance with CMS guidelines and medical
documentation requirements. Responsible for serving as final auditing
arbiter regarding the Sr. Risk & Recovery’s Retrospective Risk
Adjustment (RA) Coding Team and responsible for the identification of
training opportunities for our internal and external stakeholders
related to CMS guidelines, HCC best practices and medical record
documentation requirements.

Essential Functions:

• Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
• Provides
  regular feedback to Sr. Risk & Recovery leadership on performance
  improvement opportunities as a result of performance gaps.
• Acts as a subject matter expert to internal and external stakeholders in the area of CMS requirements and HCC best practices.
• Participates
  in and represents the department in business leadership groups,
  including external professional groups specializing in coding and
  provider education.
• Assists the business with research and documentation of workflows and policies and procedures.

Qualifications

• Must have Bachelor’s Degree in Health Sciences, Health Management, Nursing; or any combination of EDU/experience
• CPC or
  CPMA (Medical Auditing Certification) from accredited source (American
  Health Information Management Association, American Academy of
  Professional Coders, or Practice Management Institute)
• At least 5 years of experience relevant to ICD-9 coding or medical record audit experience in a consultative role
• Experience developing educational materials and delivering trainings related to ICD-9 coding

Additional Information

Advantages of this Opportunity:

Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm