Certified Medical Audit Specialist

About the Role

We are seeking a highly skilled Certified Medical Audit Specialist to join our team. In this role, you will be responsible for conducting comprehensive audits of medical records, billing practices, and documentation to ensure accuracy, compliance, and optimal reimbursement. The ideal candidate is detail-oriented, analytical, and knowledgeable about healthcare regulations and payer requirements.

Key Responsibilities

Perform detailed audits of medical records and billing data to ensure compliance with federal, state, and payer regulations. Verify accuracy of coding, documentation, and claim submissions. Identify patterns of incorrect coding, documentation gaps, or billing inconsistencies. Prepare clear, comprehensive audit reports and present findings to leadership and providers.

Collaborate with clinical and administrative staff to educate on audit outcomes and corrective actions. Stay current on regulatory changes, coding updates, and industry standards. Recommend process improvements to reduce audit risk and enhance documentation quality. Support internal compliance initiatives and participate in targeted or random audit projects.

Qualifications

Certification Preferred: Certified Medical Audit Specialist (CMAS) or equivalent. Proven experience in medical auditing, clinical documentation review, or healthcare compliance. Strong understanding of CPT, ICD-10-CM, HCPCS, and payer billing guidelines. Excellent analytical, organizational, and communication skills. Ability to work independently, manage multiple audits, and meet deadlines with accuracy.

Proficiency with EHR systems, audit software, and Microsoft Office Suite.

Preferred Skills

Experience in auditing within specialty practices (e.g., primary care, behavioral health, urgent care). Additional certifications (e.g., CPC, CPMA, RHIT, CCS) are a plus. Knowledge of Medicare, Medicaid, and commercial payer rules.

Benefits

401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Life insurance Paid time off Vision insurance