The Medical Auditor is responsible for reviewing, evaluating, and ensuring the accuracy, compliance, and quality of medical records, billing, coding, and clinical documentation. The role aims to improve healthcare service quality, ensure regulatory compliance, and optimize billing processes.
Key Responsibilities:
Conduct audits of medical records, billing, coding, and documentation to ensure compliance with healthcare regulations and standards.
Review clinical documentation to verify accuracy and completeness.
Identify discrepancies, irregularities, or errors in medical billing and coding.
Collaborate with healthcare providers, billing departments, and management to rectify issues and improve documentation practices.
Prepare detailed audit reports and recommend corrective actions.
Stay updated with changes in healthcare laws, regulations, and coding standards (e.g., ICD, CPT).
Assist in training staff on compliance and documentation standards.
Support internal and external audits related to healthcare services.
Qualifications:
Bachelor's degree in Healthcare Administration, Nursing, Medical Coding, or related field.
Certification in Medical Auditing (e.g., Certified Professional Medical Auditor - CPMA) is preferred.
Knowledge of healthcare laws, regulations, billing, and coding standards.
Strong analytical and attention-to-detail skills.
Excellent communication and report-writing skills.