Clinical Auditor

Job Description

Responsibilities:

Perform regular audits of clinical practices, patient records, and healthcare processes.
Analyze audit findings and data to identify trends, patterns, and areas of risk.
Monitor the effectiveness of implemented changes and provide ongoing support.
Ensure that the organization complies with all relevant regulatory requirements.
Develop educational materials and resources to support ongoing staff development.
Required Skills:

Registered Nurse with CIC/CCS certification and prior auditing/DRG experience preferred.
Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred.
Possesses knowledge of healthcare claims payment policy and processing – specifically CMS, Medicaid regulations, ICD-10 CM & DRG Expert, etc.
Practical clinical experience working in a hospital/office or nursing home.
Has general knowledge of medical procedures, conditions, illnesses, and treatment practices.
Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency.
Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.