13 days old

Healthcare Documentation Auditor

San Angelo, TX 76903
Regular Full Time


Focus of the Health CareDocumentation Auditor is the performance of timely and effective reviews to assess documentation and billing accuracy for post and prepayment claims onbehalf of Government, and Commercial Payers.  

Essential Functions:

  • Review medical records for services billed and validate required documents and information is contained within the records submitted for various service types as required by clients
  • Applying local coverage determination (LCD), national coverage determination (NCD), and commercial payer policy to services in review
  • Document and articulate review findings and reference the appropriate policies and rules in audit platform and as rationale language
  • Supporting findings during the appeals process if necessary
  • Working collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse
  • Partner with clients, CMD colleagues, and other contractors on improving policies, provider education, and system edits if necessary
  • Keep abreast of changes in technology and regulatory issues that may affect our business and clients
  • Suggest ideas that may improve audit work flows
  • Assist with QA functions as applicable
  • Participate in development of Review Guidelines and meetings as necessary
  • Assist with training team members as applicable
  • Cross train in other departments as applicable
  • Maintain required quality and productivity standards
  • Performs other duties as assigned



      Required Skills and Knowledge:

      • Knowledge of insurance programs, particularly the coverage and payment rules.
      • Demonstrated knowledge of medical terminology
      • Ability to maintain high quality work while meeting strict deadlines.
      • Excellent written and verbal communication skills.
      • Experience using the following applications is preferred: Word, Excel, and e-mail
      • Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a platform to review and document findings
      • Must be able to manage multiple assignments effectively,  organize and prioritize workload, problem solve, work independently and with team members
      • Courteous, professional, and respectful attitude
      • Flexibility to handle any non-standard situations that may arise

      Physical Requirements:

    • Sit/stand/walk 8-12hr/day
    • Lift/carry/push/pull under and over 10lbs occasionally
    • Keying frequency, handling, reaching, fine manipulation

    • Education and Experience:

      • High School Diploma or GED 
      • Some college preferred
      • 2+ years experience in adjudicating/examining claims for an Commercial Insurance Company, Tricare, MAC or organizations performing similar functions
      • 5+ years experience of provider professional billing, coding and documentation practices in outpatient setting, DME, home health, infusion, or hospice to Commercial Insurance Companies, Medicare, Medicaid, Tricare, or organizations performing similar functions
      • Experience in quality assurance for internal compliance of billing practices
      • Experience with ICD-9, ICD-10, CPT-4 or HCPCS coding.
      • Experience using Microsoft Excel and other Microsoft Office applications


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      Posted: 2020-07-29 Expires: 2020-09-10
      Analytics, audit, and recovery services for healthcare, government and student loans.

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      Healthcare Documentation Auditor

      Performant Financial
      San Angelo, TX 76903

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