PS-Medical Auditor-NM

Medical Auditor

Location: Albuquerque, NM

Duration: 1/29/21

Function as a clinical reviewer for HHS ACA risk adjustment and Medicare Advantage risk adjustment audits to inspect clinical records for the presence of documentation to support the validity of claims data submitted. Discern when missing medical record gaps exist and assist in directing request for additional records. Some claims inspection/research is required. Candidate must be able to work in a database environment and multiple PC apps simultaneously. Experience with Microsoft products highly recommended.

RN or LPN preferred
Associates or Bachelor degree preferred
Experience in clinical auditing or medical record review preferred
Familiarity with claims investigation or research helpful
Awareness of claims processes and claims processing systems
Organizational skills and prioritization skills
Clear and concise verbal and written communication skills
Analytical skills
Ability to deal with internal and external customers, including Representatives and Providers
PC proficiency to include Microsoft Word and Excel and health insurance databases