Independence Blue Cross
Auditor, Payment Integrity (Chart Review - Remote)
This job is now closed
Job Description
- Req#: 6772
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Fully remote position, allowing for flexibility in your work environment
- Opportunity for career advancement and growth within the organization
- Chance to make a significant impact on claims accuracy and financial integrity
- Collaborative work culture with opportunities to engage with providers and medical directors
- Supportive and dynamic team focused on achieving excellence in healthcare
What to Expect (Job Responsibilities):
- Conduct thorough medical chart reviews to ensure compliance with billing policies and claims payment standards
- Validate DRG assignment in inpatient charts based on ICD-10-CM and ICD-10-PCS coding
- Ensure adherence to CMS guidelines, payer policies, and official coding rules
- Perform audits on readmissions to identify related admissions per claims payment criteria
- Collaborate with providers and medical directors to resolve audit disputes and maintain audit documentation
What is Required (Qualifications):
- Bachelor’s degree in a healthcare-related field or business-related discipline preferred
- Current credentials of CPC, RN, or RHIT/RHIA/CCS
- Strong knowledge of medical terminology and ICD-10-CM/PCS coding guidelines
- Inpatient Medical Chart Review experience is required
- Excellent verbal and written communication skills
How to Stand Out (Preferred Qualifications):
- Understanding of Inpatient Prospective Payment System (IPPS), MSDRG, and regulatory requirements
- Analytical and detail-oriented with strong problem-solving skills
- Intermediate knowledge of MS Office: Excel, Word, Outlook
#HealthcareServices #RemoteWork #CareerOpportunity #ClaimsAuditing #AnalyticalSkills
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We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.About the company
Independence Blue Cross is a health insurer based in Philadelphia, Pennsylvania, in the United States.
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