HEDIS Medical Auditor

  • Company: Adecco
  • Posted: November 25, 2016
  • Reference ID: 2046748374
A HEDIS Medical-Auditor is available through Adecco Medical and Science. Candidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements. Local travel may be required.
HEDIS Medical Auditor duties include:
• Handle a high volume of telephonic interaction with provider offices.
• Follow up on requested medical records with providers
• Must keep excellent documentation of research and contact information
• Thoughtful and methodical search in order to locate specific claim information
• Excellent skill set to read and interpret physician handwriting
• Responsible for auditing CMS & or Commercial Insurance billing for diagnosis data collected from physician and hospital medical
• Responsible for reviewing and researching medical records to determine the accuracy of coding, billing and supporting clinical
documenation either in a health care facility or in Anthem assigned office

• 2 yrs Associate Degree through a technical school or community college
• CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American
Academy of Professional Coders or Practice Management Institute) or equivalent certification requirement.
• Must have 5+ years experience relevant ICD-9 coding or medical record audit experience in a consultative role
• Candidates must have prior experience with research and either HEDIS measures or auditing data submitted as claims
• Candidates must have computer skills and analysis capabilities in order to navigate CPT4 code and ICD9 and ICD10 DX based on
HEDIS Technical Specification requirements
• Candidates must have an understanding of codes for services based on diagnosis and procedure
• Candidates must have basic Excel skills and must have the ability to type 30-40 WPM. Prior HEDIS experience a plus.

If you are interested in this HEDIS Medical Auditior job in Northern and Southern California, please respond no later than the
COB October 25, 2016 with an updated resume for immediate consideration!
Equal Opportunity Employer Minorities/Women/Veterans/Disabled

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