Medical Auditor Resume

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Here is the Medical Auditor Resume example:

Keith Mendoza

2397 Comfort Court

Madison, WI 53703

(555)-555-5555

[email]

Job Objective To secure a position with a reputable company in which to exercise my knowledge and training as a Medical Auditor.

Work Experience:

Medical Auditor, August 2005 – Present

Slidell Memorial Hospital, Madison, WI

  • Performed prospective audits of revenue-generating departments throughout the hospital.
  • Reviewed medical record documentation upon receipt of RAC/MIC requests and provided feedback of findings.
  • Worked closely with RAC Coordinator to ensure timely review and submission of record requests and appeals.
  • Maintained retrospective/defense audits with commercial carriers and prepared monthly reports.
  • Performed patient request audits.
  • Ensured compliance with governmental and payer regulations.

Medical Auditor, May 2000 – July 2005

Aurora Health Care, Madison, WI

  • Audited medical records and hospital bills and identified problems and opportunities for improvements.
  • Researched applicable regulatory and billing rules to ensure compliant billing of hospital bill accounts.
  • Assisted in the development of processes to ensure the underlying integrity of the billing systems.
  • Identified trends/charging issues and reported to supervisor.
  • Evaluated concurrent audit reports.
  • Supported department in submitting appeals.

Summary of Qualifications:

  • Sound experience in primary care nursing, medical records coding, case management, utilization review and third party defense audits
  • Good knowledge of ICD-9, CPT and HCPCS coding
  • Proficient with Microsoft Office applications
  • Familiarity with general Medicare billing regulations
  • Ability to work independently and with a team facility
  • Excellent personal relations and customer care skills
  • Strong communication, organizational, analytic skills

Education

Bachelor’s Degree in Health Care Administration, Stony Brook University, Stony Brook, NY

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  • March 1, 2020Create Date
  • March 1, 2020Last Updated