Senior Clinical Auditor

A company is looking for a Senior Clinical Auditor. Key Responsibilities Review and analyze complex inpatient and outpatient charges to ensure accurate billing practices Ensure compliance with HIPAA regulations and monitor coding trends and regulatory updates Provide guidance and training on clinical and coding issues to internal teams and staff Required Qualifications High school diploma and 5+ years of line-item bill review experience, or completion of medical license or coding certification Extensive knowledge of inpatient and outpatient hospital billing, including UB-04 forms and coding systems Strong medical knowledge to identify inappropriate or questionable charges Knowledge of DRG and APC reimbursement methodologies Experience reviewing medical records and claim documentation