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Children's Hospital of Philadelphia | Perelman School of Medicine, University of Pennsylvania Logo
Children's Hospital of Philadelphia | Perelman School of Medicine, University of Pennsylvania

Philadelphia, Pennsylvania

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University of Maryland, Baltimore

Baltimore, Maryland

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Oregon Health and Science University

Portland, Oregon

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Duke University Health System

Raleigh, North Carolina

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Ramapo College

Mahwah, New Jersey

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Oregon Health and Science University

Portland, Oregon

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University of Southern California (USC)

Los Angeles, California

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Stony Brook University

Stony Brook, New York

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Greystar

Remote, New York

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AXA IM

London, United Kingdom

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University of Alabama, Birmingham

Birmingham, Alabama

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University of Connecticut

Storrs, Connecticut

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UT Health Science Center

Nashville, Tennessee

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UNM Hospital

Albuquerque, New Mexico

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DePaul University

Chicago, Illinois

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Banner Health

Phoenix, Arizona

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University of Alabama, Tuscaloosa

Tuscaloosa, Alabama

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Goodman Masson

London, United Kingdom

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Syracuse University

Syracuse, New York

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CHRISTUS Health

San Antonio, Texas

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Yale University

New Haven, CT

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Clinical Auditor Fraud Waste and Abuse
Job SummaryResponsible for the management of clinical reviews to assist in the prevention and detection of fraud, waste and abuse in all the Health Plan lines of business. Plan, organize, and execute medical reviews or audits that identify, evaluate and measure potential healthcare fraud and abuse.Job DutiesUtilizes an expert knowledge of CPT, ICD-9, HCPCS coding and the Health Plan clinical and reimbursement policies to review and analyze claims and corresponding medical records for clinical medical record reviews.Prepares concise clinical review summaries to support findings of potential fraud, waste and abuse Conducts in-depth research and makes recommendations to clarify coding and billing issues identified in fraud, waste and abuse cases.


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