Medical Chart Auditor (Hybrid)

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.   

The number of requests, including questioning of billed services by Cleveland Clinic, from third-party insurance companies continues to increase. This is where the Medical Chart Auditor on our team will step in. A caregiver in this position will review each charge to ensure they are compliant and valid, following coding guidelines. When necessary, they will also work on coding audits within Internal Audit's yearly audit as needed. Additionally, this caregiver may also be assigned special projects involving government audits that have also increased in volume over the last few years. Everyone on this team brings a different skillset and works well independently, allowing for schedule flexibility and cohesion. 

A caregiver in this position works days from 7:00AM – 3:30PM. This is a hybrid role with the schedule of three days working remotely and two days, Wednesday and Thursday, in-person at the Business Operations Center in Independence. 

A caregiver who excels in this role will:   

• Perform quality audits on all medical services requested by outside 3rd party payers or audit firms representing them. 

• Provide feedback to Reimbursement Managers, Institutes and Clinical areas resolving any issues uncovered during the reviews. 

• Prepare reports that include results of audits or requests. 

• Negotiate settlement of on-site reviews of Cleveland Clinic patient bills with audit representatives of 3rd party payers. 

• Develop and document audit findings, including recommendations for improving controls and reducing or recovering costs. 

• Perform concurrent reviews of Medicare cases with cost outlier status. 

Minimum qualifications for the ideal future caregiver include:   

• Bachelor's or Associate's Degree in Business Administration 

• Registered Nurse (RN), Licensed Practical Nurse (LPN) or Certified Professional Coder (CPC) 

• Coding credential including Certified Medical Audit Specialist (CMAS) ,Certified Professional Coder Hospital (CPCH), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or Registered Health Information Technician (RHIT) 

• Experience with Medicaid and Managed Care reimbursement payment policies 

• Knowledge of federal, JCAHO, state and local regulations and standards 

• Experience in generally accepted auditing principles and practices 

Preferred qualifications for the ideal future caregiver include:   

• Four years of hospital experience with medical chart reviews, CPT/ICD9 coding and billing 

• Working knowledge of information systems, effective personal computer skills and excellent oral and written communication skills 

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/