Medical Auditor (Remote)

JOB DESCRIPTION

Piper Clinical Solutions is looking for a driven Medical Auditor (Remote) to support a Fraud Waste and Abuse Special Investigations Unit with review of medical documentation and claims to guarantee proper coding rules and procedures.

Responsibilities for the Remote Medical Auditor:

• Responsible for evaluation of medical records and claims as it pertains to fraud, waste and abuse
• Complete proactive record review using knowledge of medical procedures, Medicare/Medicaid policies, coding guidelines, etc.
• Prepare written reviews for submissions to clientele, providers, and internal staff
• Utilize coding conventions, fraud schemes, reimbursement practices, and pertinent regulations to find fraudulent patterns in claims, enrollment, etc.

Requirements for the Remote Medical Review Auditor:

• 2+ years of related experience in medical review
• Certified Coder Certificate (CPC)
• Extensive knowledge of ICD9, ICD10, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, and Medicare  guidelines
• Fraud Waste and Abuse experience required
• High-level Excel competency is a must
• RN (Registered Nurse) and CPC (Certified Professional Coder) preferred

Compensation for the Remote Medical Review Auditor:

• Salary up to $75,000 based on meeting of requirements
• Benefits: Health, Dental, & Vision Insurance, 401K

Please send all qualified resumes to: dmanley@pipercompanies.com

Keywords

ICD9, ICD10, CPT, HCPCS, APC, DRG, Revenue Codes, NDCs, NCCI, priority partners, DoD, Tricare, Medicare, Medicaid, fraud, waste, abuse, FWA, Utilization Review, UR, CPC, Certified Professional Coder, medical review, coding guidelines, interqual, milliman, program integrity