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