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Claritev · 11 hours ago

Clinical Auditor-IBR

United States

Full-time

Remote

Senior Level

$75K/yr - $80K/yr

5+ years exp

Claritev is a dynamic team of innovative professionals striving to bend the cost curve in healthcare. The Clinical Auditor role involves analyzing complex claims, ensuring correct billing practices, and collaborating with clinical team members to optimize operations.

BillingHealth CarePayments

Hiring Manager

Kaytlin Beauregard

Responsibilities

Review and analyze complex inpatient and outpatient charges of various revenue centers with consideration to patient diagnosis, procedures, age and facility type including any additional information perceived as unbundled items and/or inappropriate charges

Documents audit results and updates systems accordingly. Assist management in the daily operations and processes within the department

Identify opportunities for recovery and avoidance. Researches opportunities to better control overpayments and presents ideas to management

Drive successful coding operations through the application of learned, certified knowledge in addition to continuous professional development and ongoing coding research

Provide general support to clinical team members, serving as a resource and subject matter expert (SME)

Monitors turnaround times for multiple applications and provides suggestions for process efficiencies

Uses independent decision making skills to review claims after business hours to meet deadlines

Apply national coding standards and regulations to claims billed

Research and review individual claims, claim trends or detailed itemized bills, operative notes and other documentation as needed

Monitor, research, and summarize trends, coding practices, and regulatory changes

Apply clinical judgment and high level of expertise along with analytic skills in review of the most challenging and difficult cases; including conducting additional research as needed

Communicates clinical, coding and reimbursement findings to co-workers and management in a clear, organized manner

Partner with management to drive department goals and objectives

Collaborate, coordinate, and communicate across disciplines and departments

Ensure compliance with HIPAA regulations and requirements

Demonstrate Company's Core Competencies and values held within

Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role

The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary

Qualification

Coding certificationInpatient/outpatient billingMedical insurance auditingCPT/HCPCS/ICD-10 codesPayer reimbursement policiesMedical terminologyMS Office proficiencyAnalytical skillsCustomer service skillsMentor othersCommunication skillsProblem-solving skills

Required

Completion of educational curriculum required of medical license or coding certification held, with Bachelor's Degree preferred; and at least 5 years of coding experience

Minimum 5 years experience in direct patient care, medical procedure billing, medical insurance auditing, line item review, audits, coding, and/or reimbursement

Extensive knowledge of inpatient/outpatient hospital billing including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes

Knowledge of payer reimbursement policies, state and federal regulations, medical necessity criteria, and applicable industry standards

Knowledge of commonly used medical data resources

Experience and proficiency using MS Office Suites: Excel, Outlook, and PowerPoint

Excellent communication (written, verbal, and listening), interpersonal, organizational, time-management, analytical, problem-solving, troubleshooting, and customer service skills

Ability to develop educational materials and job aids pertaining to coding and claims

Ability to work evening or weekend hours as needed to meet deadlines

Ability to handle multiple tasks in a fast-paced environment

Ability to meet individual and team goals, deadlines, and work standards

Ability to apply independent judgment and determine appropriate course of action

Ability to read and abstract medical records

Knowledge of medical terminology, anatomy, and physiology

Ability to interact and discuss results with providers

Ability to lead, teach, mentor others, and facilitate a learning environment

Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone

Preferred

Auditing and health information management experience in a healthcare setting preferred

Experience with facility contract interpretation

Benefits

Medical, dental and vision coverage with low deductible & copay

Life insurance

Short and long-term disability

Paid Parental Leave

401(k) + match

Employee Stock Purchase Plan

Generous Paid Time Off - accrued based on years of service

10 paid company holidays

Tuition reimbursement

Flexible Spending Account

Employee Assistance Program

Sick time benefits - for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits.

Company

Claritev

Glassdoor3.8

Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all.

Founded in 1980

Mclean, Virginia, USA

1001-5000 employees