Clinical Medical Records Auditor

A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug therapies through our specialty pharmacies, our infusion centers, and the home setting.

Location: Plano, Texas

The Clinical Medical Records Auditor is responsible for the audit and review of medical record documentation for the support of claim payments.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Audits provider claims for compliance to standard coding and billing practice guidelines.

• Reviews the Radiology Interpretive Report as a supporting document for CPT-4 and ICD-9 codes billed.

• Identifies providers where upcoding and unbundling of CPT-4 codes is suspect.

• Reports on findings.

• Assists the Director of HIM in the development of infusion specific coding edits.

• Reviews and renders decisions on appeals to claim clinical coding denials for improper coding or lack of preauthorization.

• Serves as resource and subject matter expert on clinical coding to internal and external customers.

Minimum Requirements:

A.S degree in related field; a minimum of 5 years of experience in ICD-9 and CPT-4 coding; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Minimum 1 year experience with procedural coding and billing strongly preferred.

• Minimum 1 year experience of clinical experience in Infusion centers/ home infusion.

• Minimum 1 year experience of reviewing medical documentation/ auditing experience