medical records auditor

Meds Nexus Pvt. Ltd.

<div>
 
 A Medical Billing Auditor is responsible for reviewing medical billing processes to ensure accuracy, compliance, and proper reimbursement. They identify errors, prevent revenue loss, and ensure adherence to healthcare regulations.
 
 
 
 
 
 Job Description:
 
 <ul>
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 Review and audit medical claims for accuracy and completeness
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 Verify CPT, ICD-10, and HCPCS coding compliance
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 Identify billing errors, fraud risks, or revenue leakage
 </li>
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 Ensure compliance with payer guidelines and healthcare regulations
 </li>
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 Analyze denied or rejected claims and suggest corrective actions
 </li>
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 Provide feedback and training to billing teams
 </li>
 <li>
 Prepare audit reports and maintain documentation
 </li>
 </ul>
 
 
 
 
 Qualification:
 
 <ul>
 <li>
 Strong knowledge of medical billing and coding systems
 </li>
 <li>
 Familiarity with insurance guidelines (Medicare/Medicaid, commercial payers)
 </li>
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 Attention to detail and analytical thinking
 </li>
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 Experience with billing software and EHR systems
 </li>
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 Good communication and reporting skills
 </li>
 </ul>
 
 
 
 
 How to apply:
 
 
 * Send your CV: careers@medsnexus.com
 
 
 * Walk-in interviews are now open &ndash; Apply today!
 
 
 * Location: Office: #1, Top Floor, Gold Mark Plaza, Asghar Mall Scheme, Asghar Mall Road, Rawalpindi
 
 
 
 
 
 Join us where expertise is valued, performance is rewarded, and growth is continuous.
 
 
 If you&rsquo;re experienced in medical billing, RCM, credentialing, or healthcare sales, 𝐌𝐞𝐝𝐬 𝐍𝐞𝐱𝐮𝐬 is the right place for your next career move
 
 
 
 
</div>

Medical Billing Auditor

sequel technologies

Location: Bahria Town Phase 7 (On-site; preference for residents of Bahria, DHA, Askari 14, or nearby areas)Company Description Sequel Technologies, a software company providing healthcare IT and medical billing services to the US market.About the Role The QA Auditor &ndash; Billing will be responsible for ensuring the accuracy, consistency, and compliance of all billing-related activities through regular quality audits. This role plays a key role in identifying process gaps, minimizing errors, and supporting continuous improvement within the billing department. The ideal candidate will have strong attention to detail, analytical skills, and a commitment to maintaining high-quality standards. Flexibility to take on additional tasks assigned by the manager is also required.Responsibilities <ul><li>Conduct quality audits on billing tasks to ensure accuracy, compliance, and adherence to standards.</li><li>Identify errors, inconsistencies, and process gaps, and provide actionable recommendations.</li><li>Maintain audit documentation and prepare reports for management review.</li><li>Collaborate with the billing team to improve quality, efficiency, and workflow accuracy.</li><li>Ensure compliance with internal policies and external billing regulations.</li><li>Perform any additional tasks assigned by the manager.</li></ul>Qualifications/Skills <ul><li>1-3 years of experience in medical billing (QA/auditing experience preferred).</li><li>Strong communication and reporting skills.</li><li>High attention to detail and ability to identify process gaps.</li><li>Understanding of billing standards, compliance, and documentation requirements.</li></ul>Timings <ul><li>6:00 PM to 3:00 AM</li></ul>Benefits <ul><li>Healthcare (OPD + IPD)</li><li>Entertainment Allowance</li><li>Cellular Allowance</li><li>Provident Fund</li></ul>Job Type: Full-timeApplication Question(s):<ul><li>Are you a resident of Bahria Town Phase 7/8, DHA 1/2, Askari 14, Gulraiz, Scheme 3 or Humak? If not, kindly state your area of residency.</li><li>The timings for this role are 5 PM to 2 AM. Are you comfortable with the timings?</li><li>This role requires an on-site interview. Will you be available for that? (we don't entertain online interviews)</li></ul>Experience:<ul><li>Billing : 5 years (Preferred)</li></ul>Work Location: In person

Medical Billing QA Auditor

<div><h2 class="jobSectionHeader">Description</h2>
<div>
As a Medical Claim Lead Auditor, you will apply your audit, project management and client management skills to lead client audits. You will serve as the team leader and primary interface with administrators. You will review discrepancy issues identified by field auditors, re-adjudicate claims, resolve open issues, and draft the final report. You will contribute to the creation of new tools and approaches.

The Responsibilities
<ul>
<li>Conduct pre-implementation and coverage specific audits and accurately document and record all audit findings</li>
<li>Understand client&rsquo;s plans and apprise team of unique provisions/issues prior to audit</li>
<li>Adjust workloads as necessary to achieve successful completion of project</li>
<li>Clearly communicate and professionally interact with vendor and audit team</li>
<li>Review documentation of potential discrepancies for thoroughness and accuracy</li>
<li>Resolve post-audit activities in an accurate and timely fashion</li>
<li>Write quality value-added draft report in a timely manner</li>
<li>Participate in client presentation of findings, when requested</li>
<li>Understand vendors&rsquo; processes, operating environment, and specific challenges and take them into account with daily work</li>
<li>Develop working relationship with vendor counterparts</li>
<li>Distribute individual claim/work queues to team in a timely manner</li>
<li>Efficiently utilize audit-specific analytic techniques, tools and processes</li>
<li>Ensure that Professional Excellence protocols are followed</li>
<li>Meet billable hours target</li>
<li>Seek opportunities to improve work processes and methods in pursuit of quality output and service delivery</li>
<li>Role will be working remotely within the posted locations.</li>
</ul>
Qualifications
<ul>
<li>5+ years&rsquo; experience in health claims adjudication gained preferably in a consulting environment and/or in a major insurance claims administrator or health plan environment</li>
<li>Solid understanding of health and welfare plan design and all areas of claims administration, as well as of vendors&rsquo; processes and operating environment</li>
<li>Familiarity with all plan types including consumer-driven, PPO, Indemnity and Managed Care</li>
<li>Must demonstrate a high level of claims administration knowledge, including experience with medical, dental, mental health and Medicare</li>
<li>Detailed knowledge of ICD-10 and CPT codes and coding protocols</li>
<li>Must have prior experience in medical claim auditing (e.g., re-evaluating medical claims that were previously processed for adherence to plan design and other program parameters).</li>
<li>Experience auditing both professional and facility claims types.</li>
<li>Must have experience auditing both benefits and pricing.</li>
<li>Excellent oral and written communications skills</li>
<li>Team player with strong work ethic</li>
<li>Self-directed; requiring very little supervision</li>
<li>Previous internal audit experience at a carrier or third-party external audit experience a plus</li>
<li>Bachelor's Degree preferred; High School Diploma required</li></ul> 

</div>
<h2 class="jobSectionHeader">Qualifications</h2>
<div>
Compensation and Benefits

Base salary range and benefits information for this position are being included in accordance with requirements of various state/local pay transparency legislation. Please note that base salaries may vary for different individuals in the same role based on several factors, including but not limited to location of the role, individual competencies, education/professional certifications, qualifications/experience, performance in the role and potential for revenue generation.

Compensation

The base salary compensation range being offered for this role is $90,000 to $98,000 USD per year.

This role is also eligible for an annual short-term incentive bonus.

Company Benefits

WTW provides a competitive benefit package which includes the following (eligibility requirements apply):
<ul>
<li>Health and Welfare: Mental health/emotional wellbeing (including Employee Assistance Program), medical (including prescription drug coverage and fertility benefits), dental, vision, Health Savings Account, Commuter Accounts, Health Care and Dependent Care Flexible Spending Accounts, company-paid life insurance, supplemental life insurance, AD&amp;D, group accident, group critical illness, group legal, identity theft protection, wellbeing program, adoption assistance, surrogacy assistance, auto/home insurance, pet insurance, and other work/life resources.</li>
<li>Leave Benefits: Paid Holidays, Annual Paid Time Off (includes paid state/local paid leave where required), Short-Term Disability, Long-Term Disability, Other Leaves (e.g., Bereavement, FMLA, ADA, Jury Duty, Military Leave, and Parental and Adoption Leave), Paid Time Off</li>
<li>Retirement Benefits: Contributory Pension Plan and Savings Plan (401k). All Level 38 and more senior roles may also be eligible for non-qualified Deferred Compensation and Deferred Savings Plans.</li>
</ul>
Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles County Fair Chance Ordinance for Employers, we will consider for employment qualified applicants with arrest and conviction records.

Note that visa employment-based non-immigrant visa sponsorship and/or assistance is not offered for this specific job opportunity.

This position will remain posted for a minimum of three business days from the date posted or until sufficient/appropriate candidate slate has been identified.

EOE, including disability/vets</div></div>

Medical Claim Lead Auditor (Remote)

Elevance Health

<div>
 
 Virtual:
 
 This role enables associates to work virtually full-time, with the exception of required inperson training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
 
 
 <ul>
 <li>
 Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
 
 
 </li>
 </ul>
 The
 
 Diagnosis Related Group Clinical Validation Auditor
 
 is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims.
 
 
 
 How You Will Make An Impact
 
 
 
 <ul>
 <li>
 Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities.
 </li>
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 Draws on advanced ICD-10 coding expertise, mastery of clinical guidelines, and industry knowledge to substantiate conclusions.
 </li>
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 Utilizes audit tools, auditing workflow systems and reference information to generate audit determinations and formulate detailed audit findings letters.
 </li>
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 Maintains accuracy and quality standards as established by audit management.
 </li>
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 Identifies potential documentation and coding errors by recognizing aberrant coding and documentation patterns such as inappropriate billing for readmissions, inpatient admission status, and Hospital-Acquired Conditions (HACs).
 </li>
 <li>
 Suggests and develops high quality, high value, concept and or process improvement and efficiency recommendations.
 
 
 </li>
 </ul>
 
 Minimum Requirements
 
 
 
 <ul>
 <li>
 Requires current, active, unrestricted Registered Nurse license in applicable state(s).
 </li>
 <li>
 Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5 years of experience working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
 
 
 </li>
 </ul>
 
 Preferred Skills, Capabilities And Experiences
 
 
 
 <ul>
 <li>
 One or more of the following certifications are preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC.
 </li>
 <li>
 Experience with third party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred.
 </li>
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 Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.
 
 
 </li>
 </ul>
 For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $81,852 to $155,088
 
 
 Locations:&Acirc; California; Colorado; District of Columbia (Washington, DC), Illinois, New Jersey; Maryland, Minnesota, Nevada; New York; Washington State
 
 
 In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.&Acirc; The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws
 
 .
 
 
 
 <ul>
 <li>
 The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
 
 
 </li>
 </ul>
 Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
 
 
 Who We Are
 
 
 Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
 
 
 How We Work
 
 
 At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
 
 
 We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
 
 
 Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
 
 
 The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
 
 
 Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
 
 
 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
 
 
 Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/) .
</div>

Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)

Alignment Healthcare

<div>Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
This is a remote position. 
The MRA Coding Auditor supports departmental Quality Assessment audits of internal Coding Analyst team and vendors to ensure accurate and complete data is submitted to CMS. Assists in Risk Adjustment related data audits (RAF, prevalence, clinical documentation improvement, P360, process) audits to identify areas of opportunity for improvement (training, data integrity, chart reviews).
GENERAL DUTIES/RESPONSIBILITIES: 
1. Supports regular quality assurance (QA) audits of internal Coding Analyst Team to validate and confirm coding &amp; abstracting quality (95% HCC accuracy). These ongoing audits ensure coding quality &amp; performance improvement standards are maintained, achieved &amp; improved per department policies and procedures. 
2. Tracks and reports progress of QA audits performed on the coding vendors to verify the coding accuracy and quality of the data submitted to AHP is accurate for submission to CMS. 
3. Works with Risk Adjustment Management on any MRA data validation / coding audit to ensure completeness and coding accuracy of all submissions to CMS. This work may encompass reviews of data for reconciliation, data flow integrity, UAT testing, high cost / low risk score members, retrospective chart reviews, or other risk adjustment related data review as directed by Manager. 
4. Analyzes and shares audit results with Manager. This information may be used for training physicians and clinical staff, documentation improvement, and system / process improvement. 
5. Utilizes, protects, and discloses Alignment Healthcare patients&rsquo; protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. 
6. Ensures compliance with all applicable federal, state &amp;local regulations, as well as with institutional/organizational standards, practices, policies &amp; procedures.
7. Maintains professional / technical knowledge by attending appropriate educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies. Stay current of industry coding, compliance, and HCC issues. Required to maintain relevant continuing education units (CEUs) in relation to individual coding certifications. 
8. Other duties as assigned to meet the organization&rsquo;s needs.
Job Requirements:
Experience:<ul><li>Required: Minimum three years of Medicare Risk Adjustment coding in a medical group or health plan setting required</li><li>Preferred:</li></ul>
Education:<ul><li>Required: High School Diploma or GED. Completion of a Medical Coding training program.</li><li>Preferred: Bachelor&rsquo;s degree in Business Administration, health Care Management or in a related field</li></ul>
Training:<ul><li>Required: Technical School or courses that are required to become a certified coder.</li></ul>
Specialized Skills:<ul><li>Required:</li></ul><ul><li>
Knowledge of</li><li>
Proficient user in MS office suite &ndash; Excel, Word, Outlook</li><li>
Previous use of Epic, Allscripts, EZCap</li><li>
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.</li><li>
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;</li><li>
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly</li><li>
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.</li><li>
Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.</li><li>
Report Analysis Skills: Comprehend and analyze statistical reports.</li></ul>
Licensure:<ul><li>Required: Certified Coder required, CCS, CCS-P, CPC, or CRC</li></ul>
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $64,384.00 - $96,577.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.<ul><li>DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health&rsquo;s talent acquisition team, please email careers@ahcusa.com.</li></ul></div>

MRA Coding Auditor - Remote

Centene

<div>You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you&rsquo;ll have access to competitive benefits including a fresh perspective on workplace flexibility. 
***POSITION IS REMOTE***
***IDEAL CANDIDATE WILL HAVE CPC OR CPMA CERTIFICATION***
Position Purpose: 
Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards.<ul><li>
Perform retrospective and prepayment reviews of medical records to identify potential abuse and fraud and inappropriate billing practices</li><li>
Investigate, analyze, and identify provider billing patterns to recommend payment based on medical records, claim history, billing codes, regulatory and state guidelines, and policies</li><li>
Prepare summary of findings and recommend next steps for providers</li><li>
Identify preventative measures and recommend changes to internal policies and procedures and/or provider practices to prevent future fraudulent and erroneous practices</li></ul><ul><li>
Consult investigators to identify abuse and fraud by utilizing clinical and coding expertise to analyze patterns in billing activities</li><li>
Performs other duties as assigned.</li><li>
Complies with all policies and standards.</li></ul>
Education/Experience: 
Associate's Degree related field or equivalent experience preferred 
2+ years related clinical experience in the field of obtained license required 
Provider education preferred 
 
Licenses/Certifications: 
Coding certification from an accredited organization (American Academy of Professional Coders or American Health Information Management Association), RN, LPC, LPN, LCSW, LMHC, PT, OT, or ST or related license. required
Pay Range: $56,200.00 - $101,000.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. 
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act</div>

Clinical Investigator I (Special Investigation Unit)

Search 10000+ Medical records auditor jobs near you this March. New roles added regularly across leading industries. Apply today.

10000 medical records auditor jobs Near Me

Medical Billing Auditor

Medical Billing QA Auditor

Medical Claim Lead Auditor (Remote)

Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)

Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)

MRA Coding Auditor - Remote

Clinical Investigator I (Special Investigation Unit)