A Medical Auditor undertakes the crucial job of checking the work of medical coders and billers. The job description entails identifying incomplete documentation that affects the facility’s livelihood. Related duties are listed on the Medical Auditor Resume as – examining the coding procedures, and ensuring the company complies with regulatory requirements; identifying fraudulent claims, outliers, inefficiencies, poor documentation, and reimbursement deficiencies; educating healthcare professionals; providing detailed recommendations to improve the company’s policies and procedures; auditing medical records, and hospital bills; and evaluating concurrent audit reports.
Summary of skills that can highlight a resume include the following – sound experience in primary care nursing, medical records coding, and case management; good knowledge of ICD-9, CPT, and HCPCS coding; familiarity with general Medicare billing regulations; and analytic skills. To handle the auditing of the medical sector, an associate’s degree in the field of health information is needed.
Summary : Exceptional skills in leadership roles, telephonic case management, field case management, medical auditing, direct and indirect health care. Well-versed in psychiatric nursing, medical-surgical nursing, workman's compensation, and long-term care. Thrive while working with the psychiatric and geriatric population and their families.
Skills : Management, Case Management, Psychiatric Home Health, Home Health, Internal Auditing, Teaching, Marketing.
Description :
Conducted routine audits of posted charges for all Florida Hospital campuses on a monthly basis.
Determined whether services ordered by physicians and rendered to patients were accurately billed and supported by documentation according to ICD9, CPT codes, and HIPPA regulations.
Prepared reports with findings and facilitated recommendations to improve procedures and enhance revenue.
Determined that accounting, operating policies and procedures, and regulatory requirements were being followed.
Provided acute care for psychiatric patients with a broad range of psychiatric and medical disorders.
Oversaw up to 7 staff and coordinated duties.
Pre-certified patients with insurance companies.
Experience
10+ Years
Level
Senior
Education
Associate In Nursing
Medical Auditor Resume
Objective : Full-time Medical Auditor position in a fast-paced environment where one can utilize previous skills in Medical claims processing.
Skills : ECG Interpretation, Airway Management.
Description :
Reviewed medical charts to check for correct documentation, charges.
Worked with staff to correct errors.
Found missing procedure charges.
Worked closely with the Revenue and Reimbursement Department to find charges.
Helped teach staff to be more careful with correct documentation.
Worked in the health care field to determine that information coding systems and organization techniques are accurate.
Conferred with company officials about financial and regulatory matters.
Experience
2-5 Years
Level
Junior
Education
Medical Coding And Insurance Billing
Medical Auditor Resume
Objective : Extensive experience in nursing procedures and care of seriously ill patients in critical care rooms. Cultivate and maintain positive and productive relationships with all contacts through solid interpersonal and communication skills.
Skills : Communication Skills, Auditing Skills.
Description :
Audited medical record documentation to identify undercoated and upcoded services.
Researched, analyzed, and responded to inquiries regarding compliance, inappropriate coding, denials, and billable services.
Interacted with providers and management to review and/or implement codes and to update charge documents.
Ensured strict confidentiality of financial records.
Attended coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
Performed miscellaneous job-related duties as assigned.
Reviewed files and charts in hospitals, clinics, and doctor's offices to make certain the health care facility is complying with standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Collect and analyze data to detect deficient controls, duplicated effort, extravagance, fraud, or non-compliance with laws, regulations, and management policies.
Experience
2-5 Years
Level
Junior
Education
BA In International Trade And Finance
Medical Auditor Resume
Summary : Level-headed DCS III, Medical Auditor, and BHT who remains calm and effective in extremely difficult and stressful situations. Strong belief in the importance of companionship and support in residential care.
Skills : Electronic Medical Records, Microsoft Office, Payment Posting, Medical Billing, Medical Coding, Medical Receptionist.
Description :
Documented resident information obtained from interviews.
Responsible for supervising DCSII and DCSII staff, train staff, and audit medication.
Authorized drug refills and provided detailed prescription information to pharmacies.
Provided behavioral/emotional support and supervision for adolescent girls that have been sexually exploited, physically and mentally abused.
Ensured safety and well-being of residents.
Researched reimbursement regulations for claim payment compliance reviews and Documentation to support current audit findings.
Utilized healthcare experience to perform audit recovery procedures.
Identified and validating incorrect claim payments.
Experience
7-10 Years
Level
Management
Education
HS Diploma In Speech And Communication
Medical Auditor Resume
Summary : Medical Auditor works with the Medical Director to identify and document the effects of medical procedures on patients. They may also work with a patient’s insurance company to negotiate discounts and fees.
Skills : Inventory Management, Staff Development & Training, Database Administration, Data Entry, Microsoft Office, MS Outlook, MicroMD, DocStar, AMM Live, EClinicalWorks, SCT-Banner, SharePoint, Rx2000, ADP Systems.
Description :
Took weekly inventory and place a medication order at each of the district's eleven offices.
Assisted doctors, physician assistants, and staff members fill prescriptions via PDRx dispensing software.
Audited 60+ prescription logs, transaction reports, patient charts, and patient billings on a daily basis.
Resolved medication dispensed errors, billing errors, and wrong diagnoses codes for each patient.
Trained managers and staff members on the new dispensing software and current hospital protocols.
Retrieved patient information in DocStar and ensuring accurate payments have been posted in MicroMD.
Reviewed clinical documentation in medical records for charge audits.
Audited medical charts against itemized hospital bills.
Audited patient accounts to ensure regulatory compliance.
Experience
10+ Years
Level
Senior
Education
BS In Psychology
Medical Auditor Resume
Headline : Ultimate team player with over fifteen (15) years of medical/secretarial experience in various settings. Develop strong working relationships with an employer and fellow employees. Proficient in problem identification, evaluation, and resolution. Achieve consistent results in all facets of office skills.
Skills : Microsoft Office, Typing 67 Wpm.
Description :
Reviewed documentation to support billing/charges, make corrections to ensure compliant billing.
Utilized coding resources for accurate CPT & HCPC coding associated with charges.
Conducted focused audits to monitor billing inconsistencies.
Educated nursing staff on audit findings.
Collaborated with Billing Office team members regarding Insurance Company and patient complaints.
Identified the root cause of Medical Necessity denials of Medicare insurer.
Educated department/understands the application of Medicare Coverage determinations to avoid future medical necessity denials.
Provided initial and ongoing claims payment training.
Audited payment of provider claims for compliance with NRS, NAC, and company policy and prepare audit results.
Tracked errors for trends and make necessary adjustments to staff training.
Experience
5-7 Years
Level
Executive
Education
BS In Nursing
Medical Auditor Resume
Objective : Seeks to secure a Medical Auditor position where acquired auditing, billing, coding, collections, and insurance experience will provide immediate benefits to the organization.
Skills : Microsoft Office, Account Management.
Description :
Responsible for planning and conducting medical functions and financial chart audits, presenting audit results to employed practices, creating, and overseeing the creation of appropriate audit spreadsheets.
Performed internal medical chart audits to assure that billing codes are appropriate and supported by documentation in the patient record, and that all coding/documentation combinations are compliant with Federal and State regulations.
Consulted with physicians and physician staff, as needed, on documentation issues, requirements for supervision of resident services, and other regulatory issues as they arise.
Reported concludes with recommendations to correct areas of deficiencies including but not limited to departmental educational training sessions.
Communicated results and findings.
Reviewed medical records for competent care and proper health management by the medical team.
Liaisoned between physicians and insurance companies.
Reported on a weekly basis, the status of all assignments, pertinent information obtained during the report week, and provide projections for the upcoming week to the Compliance Manager.
Experience
2-5 Years
Level
Junior
Education
Diploma
Medical Auditor Resume
Summary : Associate of Science in Early Childhood Education. Bilingual student with professional experience as a Front End Customer Service Clerk and as well as a Teacher. A creative, detail-oriented leader focused on providing the best customer service possible while upholding all company policies.
Skills : Microsoft Office, Computer, Typing, Customer Service.
Description :
Audited patient billing charges selected randomly on a daily basis.
Completed an audit of patient billing charges required by insurance companies that implies verification of charges accuracy.
Quito, Ecuador Medical audit of medical records of clinics in agreement with the Social Insurance IESS Ecuador as well as with Private Insurances.
Audited Medical Records for coding analysis and correct documentation according to Peruvian national guidelines.
Conducted concurrent inpatient and outpatient audits, performed patient request audits, and corresponds results in a timely manner.
Traveled to different nursing facilities for patient audits and would input their information into our computers.
Functioned as the technical expert in documentation requirements for correct coder assignments.
Responsible for knowledge of all regulatory changes affecting coding assignments and will maintain continuous monitors of Patient Treatment Files (PTF).
Experience
7-10 Years
Level
Management
Education
Associate Of Science In Early Childhood Education
Medical Auditor Resume
Objective : Seeking part-time position. Retired but would like to return to work on a part-time basis. The most current experience was in medical auditing ( which required clinical experience) but also have past work experience in clinical settings which is listed below.
Skills : Bilingual, Microsoft Office, Child Care, Pet Care.
Description :
Held progressively responsible positions in nursing in Intensive Care, Dialysis, and Emergency Room environments.
Provided recommendations to improve documentation.
Corrected errors in billing to comply with insurance.
Evaluated medical claims for commercial clients.
Evaluated professional coding and billing of acute care claims.
Evaluated ICD and CPT codes.
Examined and evaluated financial and information systems, recommending controls to ensure system reliability and data integrity.
Experience
2-5 Years
Level
Junior
Education
Business Administration
Medical Auditor Resume
Objective : Seeks to obtain a challenging, professional position utilizing education and experience. Enjoy learning new tasks and take great pride in organization and prioritization abilities. Have many years of experience working in a hectic environment with multiple interruptions and challenges.
Skills : Customer Service, Microsoft Word, Leadership, Oral/Written Communication Skills.
Description :
Performed audits on all medical records contained in health care facilities.
Reviewed data to ensure the accuracy of the record as well as assess the quality of patient care.
Performed audits of patient medical history in compliance with state law.
Ensured quality assurance of medical and pharmaceutical supplies Verified shipment's arrival at hospitals with the correct prescription.
Assisted the FDA (Food & Drug Administration) on quality to verify all control substance is handled appropriately.
In charged of handling and receiving control products class A to C.
Audited all shipments to ensure quality assurance.
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