DOMA Technologies · 1 day ago
Clinical Audit & Integrity Specialist
Annapolis Junction, MD
Full-time
Onsite
Mid Level
3+ years expDOMA Technologies is focused on data-centric transformation in healthcare, aiming to elevate health outcomes and enhance efficiency in patient care. They are seeking a Clinical Audit & Integrity Specialist to provide medical expertise for audit activities, review medical records, and ensure compliance with clinical standards.
Cloud Data ServicesDocument ManagementEnterpriseInformation TechnologySoftware
Responsibilities
Review medical records to assess medical necessity and appropriateness of services
Provide clinical expertise on audit findings and investigation cases
Evaluate whether services provided meet accepted standards of care
Assess documentation quality and completeness to support billing
Identify medically unnecessary, excessive, or inappropriate services
Collaborate with auditors on clinical aspects of overpayment calculations
Prepare clinical summaries and findings for inclusion in audit reports
Provide education to audit staff on clinical issues and terminology
Consult with specialized practitioners (dentists, pharmacists) as needed
Participate in case conferences and provide clinical perspective
Stay current on clinical practice guidelines and Medicaid coverage policies
May provide testimony in administrative hearings regarding clinical findings
Qualification
Required
Current and active Indiana Registered Nurse (RN) license or higher
Minimum 3 years of clinical nursing experience in acute care or specialty practice
Strong clinical knowledge across multiple specialties and care settings
Understanding of medical necessity criteria and documentation requirements
Familiarity with medical coding and clinical documentation standards
Ability to identify clinically inappropriate or excessive services
Excellent medical record review and analysis skills
Strong written and verbal communication abilities
Critical thinking and clinical judgment
Ability to collaborate with non-clinical team members
Available for meetings and consultations as needed
Successfully pass background check
Subject to State approval
Preferred
Bachelor of Science in Nursing (BSN) preferred
Advanced practice certifications (NP, CNS) valued
Coding certifications (CPC, CCS) beneficial
Experience with utilization review, case management, or quality assurance preferred
Medical record review experience highly valued
Familiarity with Medicaid program and coverage policies beneficial
Company
DOMA Technologies
DOMA is a game changing tech innovator that frames all of its endeavors through its passion for people.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2024-11-13Acquired
Leadership Team
Pat Feliciano
President & CEO
Damian Breland
Chief Technology Officer
Recent News
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