About the role
Lead the claim audit team in reviewing inpatient and outpatient medical records.Validate documentation supports billed items and codes.Identify documentation deficiencies, coding errors, or mismatches.Communicate with physicians for clarification or missing data.Generate audit reports and denial analysis.Liaise with billing to prevent rejections or address payer queries.Provide training to clinical staff on medical necessity documentation.
Education: Bachelors in Medicine, DentistryExperience: 3-6 years in medical auditing or claimsSkills:Proficient in medical coding systems (ICD-10, CPT)Skilled in EMR and HIS navigation for data verification and documentation reviewCompetent in using audit reporting tools for trend analysis, denial tracking, and performance reportingAble to interpret insurance policies, pre-authorization protocols, and payer-specific coding requirementsFamiliar with JCI documentation standards and clinical workflow processes
Education: Bachelors in Medicine, DentistryExperience: 3-6 years in medical auditing or claimsSkills:Proficient in medical coding systems (ICD-10, CPT)Skilled in EMR and HIS navigation for data verification and documentation reviewCompetent in using audit reporting tools for trend analysis, denial tracking, and performance reportingAble to interpret insurance policies, pre-authorization protocols, and payer-specific coding requirementsFamiliar with JCI documentation standards and clinical workflow processes
