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Nurse Auditor
Summary Primarily responsible for reviewing medical and/or behavioral health claims and clinical documentation in relation to investigations of possible fraud, waste or abuse. Verify correct billing and/or coding of ICD-10 and CPT codes of health plan claims according to medical record documentation. Identification of medical record support for global/bundled codes. Prepare a detailed written report of the audit findings and present the findings to the SIU Program Manager and the Compliance Director.Education & Experience


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