Medical Auditor

at MaineHealth in Scarborough, Maine, United States

Job Description


This Position has the ability to be 100% Remote for the candidate with the right credentials
Position Summary:
MaineHealth is looking for a dynamic individual to join our Commercial Charge Auditing Team. MaineHealth is looking for an individual that has Hospital Charge Master experience and/or clinical insight and experience with billing from a charge perspective. The position entails reviewing medical necessity and supporting charge documentation. Assess clinical documentation for supporting medical necessity to appeal denials or audits. Registered Nurses that have this type of experience are strongly urged to apply. Coding Certifications such as CPC or CIC are preferred. If you possess these qualifications and are interested in joining a team that is passionate about making a difference, apply today.
Required Minimum Knowledge, Skills, and Abilities (KSAs)
Education: Bachelor's degree in Healthcare and or related field.
License/Certifications: CPC, COC or other coding certification preferred. Current licensure as a registered nurse preferred.
Experience: 3-5 years' coding and/or clinical experience required.
Current knowledge of CPT, HCPCS, Revenue and ICD9/10 codes.
Current knowledge of the rules and regulations as they relate to State and Federal Government and 3rd Party Payers. Including an in-depth understanding of Medicare's LCD and NDC medical necessity guidelines, appeals process and timelines.
Knowledge of broad range of medical and psychiatric diagnoses, current treatment modalities, therapeutic service and intervention techniques.
Ability to take initiative; be self-directed and exercise consistently sound judgment in making appropriate decisions regarding denials and appeals.
Interpersonal skills sufficient to communicate effectively with a variety of clinicians, hospital personnel, and well as third party reimbursement personnel.
Ability to communicate effectively, using a high degree of diplomacy and sensitivity in verbal and written communication in order to achieve the desired outcome
Ability to work under pressure, and to maintain patience in difficult situations as well as to cope with a high volume work load.
Ability to adapt to new or consistently challenging problems, procedures, and policies.
Familiarity with medical records, health information management systems.
Additional Information

MaineHealth was ranked one of America's Best Large Employers in 2022 by Forbes!

MaineHealth is a not-for-profit integrated health system whose vision is, "Working together so our communities are the healthiest in America." MaineHealth consists of nine local health systems, a comprehensive behavioral health care network, diagnostic services, home health agencies, and 1,700 employed clinicians working together through the MaineHealth Medical Group. With approximately 22,000 care team members, MaineHealth provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire. Learn more about our system at

At MaineHealth, we offer benefits that support an individual's needs for today and flexibility to plan for tomorrow. Our packages include health and dental insurances, paid parental leave, retirement program, generous paid time off, and much more! Our comprehensive array of benefits are competitive, affordable, and include choices that meet specific, but ever changing, needs.

With a career at any of the MaineHealth locations, you'll be working with health care professionals that truly value the people around them - both within the walls of the organization and the neighborhoods that surround it. We are deeply invested in the well-being of our communities and care team members. We believe in fostering a work environment of strong commitment, compassionate caring and continuous improvement. Join us, and your abilities will be challenged and enhanced as you take your career to a new level.
Additional Information  MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at

MaineHealth values diversity and is an Equal Opportunity/Affirmative Action employer. Federal and state laws prohibit discrimination in employment because of race, color, national origin, religion, age, sex, sexual orientation, disability or veteran status.

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Job Posting: 854305

Posted On: Nov 29, 2022

Updated On: Nov 29, 2022

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