Intermediate Clinical Auditor/Analyst, QA – Remote

About the positionResponsibilities• Review and analyze claims, medical records, and associated processes related to coding and clinical care.• Provide clinical opinions for special projects and auditing activities.• Complete audits using standard coding guidelines to verify appropriate CPT codes/DRGs.• Assess, investigate, and resolve complex issues.• Write concise reports to communicate findings to other areas of UPMC Health Plan.• Communicate effectively with Medical Directors and ancillary departments.• Participate in special projects and other auditing activities as needed.• Assist other departments as requested.• Understand internal and external customer issues to identify solutions.• Serve as a QA/OI Department representative at meetings and present findings.• Assist in developing and revising QA/OI department policies and procedures.• Perform audit peer reviews for Clinical Auditor/Analysts.• Provide new-hire training to Clinical Auditor/Analysts.• Design and maintain reports and auditing tools.Requirements• Registered Nurse (RN) with a Bachelor of Science in Nursing (BSN) or equivalent education and experience.• Five years of clinical experience.• Three years of fraud & abuse, auditing, case management, quality review, or chart auditing experience.• In-depth knowledge of medical terminology, ICD-10, and CPT-4 coding.• Detail-oriented with excellent organizational skills.• High level of oral and written communication skills.• Proficiency with Microsoft Office products (Excel, Access, OneDrive, OneNote, Word).• Experience with DRG Assignment and clinical validation of diagnoses.• Licensure and certifications such as AAPC or AHIMA Certified (CPC, CPMA, CIC, CCA, CCS, CCS-P, CRC) required.Nice-to-haves• Experience with HCC/Risk Adjustment coding preferred.• Proficiency using Epic, One Content, and/or Power Chart preferred.Benefits• Full-time position with competitive hourly wage.• Remote work flexibility.• Opportunities for professional development and training. Apply tot his job Apply To this Job