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Clinical Compliance Auditor

Company name
Childrenu2019s Minnesota

Edina, MN

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Description : Department Overview The corporate compliance department is committed to promoting an ethical culture at Children's Hospitals and Clinics.These efforts are advanced by ensuring integrity in business practices, providing continuous education and promoting collaborative relationships with all customers. Position Summary This position is responsible for conducting audits to assure billed services are in compliance with federal\/state regulations and guidelines. The Clinical Compliance Auditor will evaluate the appropriateness and medical necessity of services and procedures billed based on supporting documentation. The Clinical Compliance Auditor is responsible for performing all audit fieldwork, as well as preparing written and oral communication to appropriate individuals on the audit results. Qualifications :: Education: * Clinical bachelor's degree preferred. Experience: * Previous experience applying Milliman or InterQual care guidelines (preferred) * Previous experience auditing inpatient and outpatient facility and technical fees (preferred) Knowledge\/Skills\/Abilities: * Milliman\/InterQual care guidelines. * Medicaid and third party payer documentation and coding policies and guidelines. * Coding principles\/guidelines. * Intermediate to advanced computer skills in Microsoft Word and Excel. * High level attention to detail. * Proficient writing skills.

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Childrenu2019s Minnesota

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