Senior Executive

• The Clinical Auditor performs reviews, analyzes, and codes documentation from medical records that determines payments.
• This position performs highly technical and specialized functions, and the primary function of this position is to perform a thorough review of patient encounters to assess for completeness and accuracy of provider documentation and ICD-10-CM, CPT and HCPCS coding.
• The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

• Bachelor’s degree (or equivalent) in Nursing.
• NCLEX certification – Active(USRN)
• Able to apply analytical and critical thinking to record reviews.
• Required comprehensive clinical knowledge and strong clinical experience.
• All certifications/License should be active.

• Certified professional coder (CPC) - AAPC
• Auditing experience on US Medical Coding.
• Knowledge in Microsoft outlook/excel/word
• Exposure on 3M software and NLP tool.

• Performs clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding.
• Integrates coding principles in performance of medical audit activity and educates as needed on those principles
• Upon completion of medical record audit, compiles detailed findings and prepares client reports, when needed.
• Coordinates with client to ensure patient data is received and processed for all scheduled audit work
• Communicate proper volume to support invoicing.
• Provides feedback and process improvement recommendations to appropriate leadership team and participates in workgroups/committee meetings and process improvement solutions as required.
• Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise.

• Participates in and/or leads inter-departmental process improvement initiatives.
• Identifies compliance risks and financial opportunities based on chart reviews.
• Prepares reports and executive summaries as required by management regarding audit results, process improvement recommendations, and systemic billing errors.
• Adheres to established productivity standards, participates in departmental performance improvement activities and work level.
• Communicates and works with all internal and external customers.
• Performs other duties as assigned.

EXL Service