Our organization is a leading player in the healthcare industry, committed to maintaining the highest standards of accuracy and compliance in clinical documentation and medical billing. We partner with healthcare providers to ensure seamless operations, accurate reimbursements, and adherence to payer and regulatory guidelines.

Responsibilities of the Job

As a Clinical Documentation Reviewer, your key responsibilities will include:

1. Review and Audit Documentation:
   • Analyze patient records, medical charts, and progress notes to ensure they match the coded data in the billing system.
2. Ensure Documentation Accuracy:
   • Verify that clinical documentation includes all required details such as patient history, treatment plans, diagnoses, and procedures to meet billing standards.
3. Ensure Compliance:
   • Maintain adherence to HIPAA, CMS, and payer-specific guidelines.
4. Collaboration with Providers:
   • Work closely with healthcare providers and clinical teams to clarify discrepancies and improve documentation practices.
5. Training and Education:
   • Provide guidance and training to clinical and coding teams on improving documentation quality and avoiding common errors.
6. Identify Documentation Gaps:
   • Spot gaps that may impact claims processing and billing accuracy and report these issues proactively.
7. Audit and Monitor Submissions:
   • Perform audits to ensure coding and billing data aligns with clinical records for accurate reimbursement.
8. Denial Management:
   • Assist in resolving claim denials by identifying documentation issues and suggesting corrective actions.
9. Maintain Documentation Standards:
   • Stay updated on medical billing, coding, and regulatory changes to ensure the highest level of compliance.

Qualifications

• Bachelor’s degree in Healthcare Administration, Nursing, Life Sciences, or related field.
• 1–4 years of experience in clinical documentation, medical billing, or coding.
• Knowledge of ICD-10, CPT, and HCPCS codes is an advantage.
• Familiarity with compliance standards such as HIPAA and CMS guidelines.

Skills Required

• Strong attention to detail and analytical skills.
• Excellent written and verbal communication skills.
• Proficiency in using medical billing and coding software.
• Ability to collaborate effectively with healthcare teams.
• Problem-solving abilities to address documentation gaps and billing issues.

Application Link