Claims Quality Audit Manager manages the claims quality auditors and daily activities of quality claims audit function. Reviews and tracks claims quality audit reports and measures performance of auditors. Being a Claims Quality Audit Manager provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit. Additionally, Claims Quality Audit Manager typically requires a bachelor's degree. Typically reports to a director or head of a department. The Claims Quality Audit Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Claims Quality Audit Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)
Job Title: Quality Assurance Auditor
Job Summary: We are seeking a seasoned healthcare documentation and coding Quality Assurance Auditor. The ideal candidate will have extensive experience in healthcare documentation and coding. In this role, you will be responsible for documenting patient visit chart notes, auditing completed chart notes for accuracy and thoroughness, and verifying the appropriate ICD-10, CPT, and HCPCS codes are assigned to each chart note.
Responsibilities:
· Listening to and documenting patient visits in the electronic health record
· Auditing chart notes within the electronic health record that have been created by our technology for accuracy and completeness.
· Assigning all appropriate ICD-10, CPT, and HCPCS codes to chart notes
· Auditing ICD-10, CPT, and HCPCS codes that have been applied to chart notes by our technology.
· Working closely with the Quality Assurance Team Lead and/or Director of Quality Assurance to create workflow policies and procedures for the department
· Communicating with the Quality Assurance Team Lead, Training and Implementation Department and/or providers to ensure satisfaction of newly onboarded practices and providers
Requirements:
· 5 years of experience in healthcare documentation and coding
· One of the following credentials: CPC, COC, CPMA, CPPM, CDEO, CPMS
· Strong knowledge of claims adjudication processes and regulatory requirements
· Strong knowledge of documentation and coding processes and regulatory requirements
· Experience with EHR/EMR technology
· Strong analytical and problem-solving skills, with the ability to use data to drive decision-making and process improvement
· Excellent communication and interpersonal skills, with the ability to build relationships and collaborate effectively with cross-functional teams and external partners
· Ability to work independently and manage multiple priorities in a fast-paced, dynamic environment
· Experience working in a healthcare technology company or similar environment is a plus
We offer a competitive salary, comprehensive benefits package, and a dynamic work environment that fosters creativity, innovation, and growth. If you are a strategic thinker, a strong leader, and passionate about healthcare and operational excellence, we encourage you to apply for this exciting opportunity.
Job Types: Full-time, Permanent
Pay: $19.00 - $25.00 per hour
Expected hours: 40 – 60 per week
Benefits:
Experience level:
Schedule:
Work setting:
Ability to Relocate:
Work Location: In person
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