Sr. Internal Auditor focusing on IT compliance and risk management for ISO 27001 standards. Leading internal audits and preparing for external certifications for a tech company.
About the role
- Senior Executive auditing medical claims for healthcare to ensure documentation accuracy and compliance with CMS regulations. Collaborating with teams to improve claims processes and audit findings.
Responsibilities
- 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.
- Provide structured findings and audit reports with clear recommendations for corrective action and process improvement.
- Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions.
- Monitor trends in audit results and identify recurring issues requiring targeted education or intervention.
- Support quality assurance initiatives by maintaining audit accuracy benchmarks and meeting productivity standards.
- Participate in continuous improvement activities, including updates on CMS regulations, clinical guidelines, and payer policy changes.
Requirements
- Bachelor’s degree in nursing
- Active State Nursing certification is Mandatory
- Minimum 3 years of clinical/hospital experience is mandatory
- Minimum 3 years of clinical experience.
- Auditing experience (Optional)
- Strong written (documentation) and oral communication skills
Benefits
- 40 hours per week as Full-time employee
- Weekends: Off
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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