Related skills
hipaa cpc forensic_audit medical_records_review cms_regulations📋 Description
- Identify and audit aberrant billing patterns in claims
- Review pre-/post-payment medical records for guideline alignment
- Analyze provider behavior for cloning, upcoding, and unbundling
- Translate audit findings into education for Oscar teams
- Build evidentiary files for recovery, legal action, or referrals
- Report to the Investigations Manager, SIU
🎯 Requirements
- Active, unrestricted RN license
- 3+ years direct patient care clinical experience
- 2+ years in Medical Review/Utilization Management/CDI with forensic focus
- Experience conducting forensic medical audits validating CPC/HCPCS/ICD-10 codes
🎁 Benefits
- Medical, dental, and vision benefits
- 11 paid holidays, paid sick time, parental leave
- 401(k) plan participation
- Unlimited vacation program
- Annual performance bonuses
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