Senior Executive - Clinical Auditor

About the role

Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors. Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards. Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes.

What you'll do

• Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation
• Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors
• Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards
• Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes
• Conduct best practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities

What you need

• 3–6 yrs of experience
• Audit
• Compliance
• SOP writing
• Any graduate