Payment Integrity Auditor

A company is looking for a Payment Integrity Auditor to ensure accurate claims payment and uphold compliance through detailed chart reviews.

Key Responsibilities

Perform medical chart reviews to ensure adherence to billing and payment policies

Review inpatient charts for DRG assignment validation based on coding guidelines

Collaborate with providers to resolve audit disputes and maintain audit documentation

Required Qualifications

Bachelor's degree in a health care-related field or business-related discipline preferred

Current credentials of CPC, RN, or RHIT / RHIA / CCS

Strong knowledge of medical terminology and ICD-10-CM / PCS coding guidelines

Inpatient Medical Chart Review experience is required

Understanding of Inpatient and Outpatient Prospective Payment System regulations