Related skills
hipaa regulatory compliance cpc forensic auditing claims review📋 Description
- Identify and audit aberrant billing patterns in claims
- Perform pre- and post-payment reviews of medical records
- Detect schemes like cloning, upcoding, and unbundling
- Translate audit findings into education for Oscar teams
- Facilitate discussions with providers to correct billing behavior
- Build evidentiary files for potential recovery or referrals
🎯 Requirements
- Active, unrestricted RN license
- 3+ years direct patient care clinical experience (case mgmt bonus)
- 2+ years in Medical Review, Utilization Management, or CDI with forensic guidelines (MCG/CMS)
- Forensic medical audit experience; validate narratives support CPC/HCPCS/ICD-10
🎁 Benefits
- Medical, dental, and vision coverage
- 11 paid holidays and paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
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