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Senior Review Auditor
TX - Irving
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We currently have an opening for:Senior Review AuditorThe Senior Review Auditor oversees daily activities of Audit staff.The successful individual will provide daily guidance to Medical Review Nurses, audit coordinators, administrative support and data extraction representatives; monitor overall workload to identify potential and actual backlogs; work with Audit Manager to resolve and/or prevent work backlogs; oversee and review determinations in order to ensure the consistency of decision-making by medical review nurses, coders and other allied health care professionals participate in meetings with other medical review entities to discuss procedure and policy; review the QA results and, when needed, plan corrective action; and maintain relationships with subcontractor, provider office, including regular participation in conference calls.Requirements for this position:Bachelor’s degree in healthcare related field required.Registered Nurse (RN) license in good standing is preferred.Certified Public Accountant (CPA) preferred.Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or other coding certification required.Minimum of three years performing medical record documentation review, utilization review or nursing experience.Minimum of two years supervisory experience in the area of medical/utilization review.Familiarity with GAGAS and GAAS principles.Extensive knowledge of HIPAA Privacy and Security Rules and CMS security requirements.Shows longevity in employment with one or more past employers.Excellent written and verbal communication skills including public speaking and human relations, and ability to produce work free from typographical or spelling errors.Working knowledge of Microsoft Office, Internet and e-mail.Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid.Ability to travel up to 35% is required.
We currently have an opening for:Senior Review AuditorThe Senior Review Auditor oversees daily activities of Audit staff.The successful individual will provide daily guidance to Medical Review Nurses, audit coordinators, administrative support and data extraction representatives; monitor overall workload to identify potential and actual backlogs; work with Audit Manager to resolve and/or prevent work backlogs; oversee and review determinations in order to ensure the consistency of decision-making by medical review nurses, coders and other allied health care professionals participate in meetings with other medical review entities to discuss procedure and policy; review the QA results and, when needed, plan corrective action; and maintain relationships with subcontractor, provider office, including regular participation in conference calls.Requirements for this position:Bachelor’s degree in healthcare related field required.Registered Nurse (RN) license in good standing is preferred.Certified Public Accountant (CPA) preferred.Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or other coding certification required.Minimum of three years performing medical record documentation review, utilization review or nursing experience.Minimum of two years supervisory experience in the area of medical/utilization review.Familiarity with GAGAS and GAAS principles.Extensive knowledge of HIPAA Privacy and Security Rules and CMS security requirements.Shows longevity in employment with one or more past employers.Excellent written and verbal communication skills including public speaking and human relations, and ability to produce work free from typographical or spelling errors.Working knowledge of Microsoft Office, Internet and e-mail.Not currently sanctioned or excluded from any program operated by Federal or State Agencies including Medicare and Medicaid.Ability to travel up to 35% is required.
HMS is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
