Medical Auditor Resume Examples

Highly organized individual with strong attention to detail.Strong analytical skills coupled with clear communication and documentation in medical records.Detailed report preparation for individual department heads and broad summary reports for the Compliance Committee.

• Knowledge of CPT and ICD-9 coding
• Report preparation skills
• Analytical ability
• Confidentiality
• Knowledge of federal and state compliance regulations
• Medical terminology

• Reduced incidence of governmental investigational auditors by 30 percent over five years while case load increased by 55 percent for the same time period.
• Performed audits specifically targeting and evaluating procedural diagnosis code selection.
• Presented audit findings and identified opportunities within the organization for training.
• Identified fraudulent claims.
• Identified and corrected problems before government and insurance payers could challenge incorrect coding.

• Reviewed medical claims to detect unlawful or incorrect Medicare payments.
• Conducted quality assurance assessments and reviewed statistical samples.

• Utilized CPTS ICD-9 and other coding systems with emphasis on compliance and regulatory standards.
• Communicated results and findings.