Medical Auditor Jobs

About us:

HEART. It is the driving force of our commitment to serving others with empathy, respect, and dignity. CareMax, is committed to providing the best that medicine has to offer with quality healthcare for those who need it most, our seniors. Join our team and experience it for yourself. We are Health with Heart.

You can count on us to provide you with resources and opportunities for growth, while contributing to our mission to improve lives through kindness, compassion, and better health. This is what we offer:

• Comprehensive medical package
• Starting with 18 days of Paid Time Off
• 8 company paid holidays plus a floating holiday
• 401(k) plan with company match
• Access to continual education through CareMax University

About you:

As a Medical Auditor, you'll ensure the accuracy of outpatient medical records by reviewing medical records and identifying potential coding errors. You'll prepare reports and meet with management to improve coding practices, ensuring compliance with regulations and minimizing errors. You'll also optimize billing by identifying opportunities through audits and observations. Stay current with the latest regulatory and procedure changes to ensure that patients receive the best care. Join our team and make a meaningful impact on healthcare.

Qualifications And Skills

• Certified Professional Medical Auditor (CPMA) -required
• Ability to speak effectively with employees, Providers, clinical staff visitors and management
• Minimum three years of coding, billing and audit/chart review experience is required. Medical Coder II or III
• Ability to compose routine reports and correspondence.
• Medicare Advantage, Medicaid, and outpatient coding experience or equivalent.
• Must remain coder-auditor certified while performing their duties.
• Certified Documentation Expert Outpatient (CDEO) ----preferred
• Certified Risk Adjustment Coder (CRC)-required
• Ability to read and interpret documents, such as policies and procedures, benefits information, benefit surveys, board minutes, routine mail, simple contracts, and procedure manuals.
• Working knowledge of billing for a multi-discipline practice and general computer systems required
• Certified Professional Coder (CPC)-required
• Must demonstrate a clear understanding of medical terminology, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Disease (ICD) coding.

Essential Duties And Responsibilities

• Ensuring and monitoring completion and accuracy of all encounter forms for all new and continuing patients.
• Educating team members on coding best practices and procedures to meet compliance and regulatory requirements.
• Reviewing medical records to verify appropriateness of medical record diagnosis, supporting documentation, and coding for services rendered to members, ensuring compliance with all applicable laws and regulations.
• Utilizing audit results to provide data-driven feedback to providers and management to improve coding accuracy and identify opportunities for improvement and re-training.
• Collaborating with interdepartmental or cross-functional teams for assigned projects and providing departments with coding issues and updates to be shared with providers to ensure timely and accurate claim payment.
• Performing all other duties as assigned.
• Assisting business services with maintenance of data files necessary to perform tasks.
• Reviewing assigned ICD-10-CM codes and maintaining coding quality, while monitoring accuracy at various levels of detail and highlighting areas of improvement.
• Reviewing payment denials, underpayments, and payment take backs, guiding resolution by resubmission to the insurance carrier, patient billing, or appropriate adjustment.
• Collaborating with providers to clarify diagnoses, procedure coding, and documentation requirements, including proper sequencing, to ensure accuracy and compliance with regulations.
• Complying with organizational policies and procedures.

Come join the CareMax family and be part of Health with Heart. Help us continue to change lives every day!

CareMax provides equal employment opportunity to all applicants and employees. No person is to be discriminated against in any aspect of the employment relationship due to race, religion, color, sex, age, national origin, disability status, genetics, citizenship status, marital status, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws

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