Medical Auditor

ExactCare

. Perform clinical validation audits and interpret medical documentation to ensure accurate capture of patient conditions in compliance with coding guidelines .

Posted 11/3/2026full-timeRemote • New Jersey • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical validation audits and ICD-10-CM coding, ensuring compliance with coding guidelines and effective communication with clients. Maintains professional certifications while contributing to process improvements and clinical documentation enhancement.

Highest-signal resume keywords

Professional Medical Coder CertificationICD-10-CM Coding ExperienceClinical Documentation ImprovementExperience With Hierarchical Condition CategoriesKnowledge Of Medicare Advantage Plans

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Validation AuditsICD-10-CM CodingMedical Documentation InterpretationAudit ReportingProcess Improvement RecommendationsCoding Principles ApplicationClient CommunicationData Analysis

Soft Skills

Attention To DetailEffective CommunicationTeam CollaborationProblem Solving

Tools & Technologies

MS WordExcelPowerPointProprietary Software

Certifications & Qualifications

CCS CertificationCPC CertificationRHIT CertificationCRC CertificationCPMA Certification

Industry Keywords

HIPAA ComplianceManaged Health Care SystemsMedicareMedicare Advantage PlansPACE

About the role

Key responsibilities & impact

Perform clinical validation audits and interpret medical documentation to ensure accurate capture of patient conditions in compliance with coding guidelines
Conduct prospective, retrospective, and RADV audits as requested by clients
Apply coding principles during medical audit activities and provide education as needed
Compile detailed findings and prepare client reports after medical record audits
Review audit results with clients monthly or as needed
Provide feedback and process improvement recommendations to the Client Service Liaison
Participate in workgroups, committee meetings, process improvement initiatives, department meetings, client calls, and performance evaluations
Advise the Client Service Liaison of potential trends in inappropriate utilization
Maintain current professional licenses and certifications
Attend training conferences, webinars, workshops, and review industry publications to stay current on ICD-10-CM coding, documentation, laws, and regulations
Adhere to HIPAA requirements
Embody AnewHealth’s core values
Perform other duties as assigned

Requirements

What you’ll need

Professional Medical Coder Certification: CCS issued by the American Health Information Management Association, CPC, or RHIT with 6 months of ICD-10-CM coding experience
CRC certification preferred
CPMA preferred
Experience in clinical documentation improvement
Experience with Hierarchical Condition Categories (HCC)
Knowledge of or experience with Medicare Advantage plans
Knowledge of or experience in managed health care systems, PACE, or Medicare
Experience with MS Word, Excel, and PowerPoint
Comfortable learning and becoming an expert on new and proprietary software
Must maintain professional license and certifications
Must be able to commute to multiple site locations within assigned territory
May be required to work extended hours
Availability outside normal business hours on an ad-hoc basis
Applicants must be eligible to work in this country

Benefits

Comp & perks

Medical, dental, and vision coverage
Flexible spending account
Company-paid life insurance
Short-term disability coverage
Voluntary benefits
401(k)
Paid Time Off
Paid holidays
Flexible remote work arrangement